Provider Demographics
NPI:1053605089
Name:MACIAS, ANN ELISE (PHARMD, RPH)
Entity type:Individual
Prefix:
First Name:ANN
Middle Name:ELISE
Last Name:MACIAS
Suffix:
Gender:F
Credentials:PHARMD, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2195 E PROSPERITY AVE
Mailing Address - Street 2:
Mailing Address - City:TULARE
Mailing Address - State:CA
Mailing Address - Zip Code:93274-7754
Mailing Address - Country:US
Mailing Address - Phone:559-631-1129
Mailing Address - Fax:559-631-1139
Practice Address - Street 1:2195 E PROSPERITY AVE
Practice Address - Street 2:
Practice Address - City:TULARE
Practice Address - State:CA
Practice Address - Zip Code:93274-7754
Practice Address - Country:US
Practice Address - Phone:559-631-1129
Practice Address - Fax:559-631-1139
Is Sole Proprietor?:No
Enumeration Date:2011-06-07
Last Update Date:2011-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA65258183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist