Provider Demographics
NPI:1063708881
Name:PASS, MARINA (PHARM D)
Entity type:Individual
Prefix:DR
First Name:MARINA
Middle Name:
Last Name:PASS
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2727 W AGUA FRIA FWY
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85027-3929
Mailing Address - Country:US
Mailing Address - Phone:623-869-7330
Mailing Address - Fax:
Practice Address - Street 1:2727 W AGUA FRIA FWY
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85027-3929
Practice Address - Country:US
Practice Address - Phone:623-869-7330
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-20
Last Update Date:2016-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS013596183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist