Provider Demographics
NPI:1588948293
Name:ENDELEY-MATUTE, MARIANA MOJOKO (RPH)
Entity type:Individual
Prefix:
First Name:MARIANA
Middle Name:MOJOKO
Last Name:ENDELEY-MATUTE
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 NEMOURS CT
Mailing Address - Street 2:
Mailing Address - City:MAUMELLE
Mailing Address - State:AR
Mailing Address - Zip Code:72113-6751
Mailing Address - Country:US
Mailing Address - Phone:501-626-3483
Mailing Address - Fax:501-812-5739
Practice Address - Street 1:2500 MCCAIN BLVD
Practice Address - Street 2:
Practice Address - City:NORTH LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72116-7609
Practice Address - Country:US
Practice Address - Phone:501-812-6228
Practice Address - Fax:501-812-5739
Is Sole Proprietor?:No
Enumeration Date:2011-09-30
Last Update Date:2011-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPD100301835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy