NPI 1033769302

Brian Ma

Practitioner Pharmacist Winslow, AZ

Practice location

Address: 500 N Indiana Ave, Winslow, AZ 86047-8604
Phone: (928) 289-6215
Mailing address: 3247 S Marryvale Ln, Flagstaff, AZ 86005-6568

Registered specialties

Pharmacist Primary

Pharmacy Service Providers Taxonomy 183500000X Licence 26185 (MD)

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Registry record

NPI: 1033769302
Entity type: Individual
Sex (as registered): Male
NPI issued: 18 Sep 2019
Record last updated: 18 Sep 2019

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.