Provider Demographics
NPI:1811260953
Name:MAES, REBECCA MARIA (PHARM D)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:MARIA
Last Name:MAES
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 1:1301 10TH ST
Mailing Address - Street 2:
Mailing Address - City:ALAMOGORDO
Mailing Address - State:NM
Mailing Address - Zip Code:88310-5804
Mailing Address - Country:US
Mailing Address - Phone:575-437-5530
Mailing Address - Fax:575-434-3237
Practice Address - Street 1:1301 10TH ST
Practice Address - Street 2:
Practice Address - City:ALAMOGORDO
Practice Address - State:NM
Practice Address - Zip Code:88310-5804
Practice Address - Country:US
Practice Address - Phone:575-437-5530
Practice Address - Fax:575-434-3237
Is Sole Proprietor?:No
Enumeration Date:2012-02-21
Last Update Date:2012-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMRP00007483183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist