Provider Demographics
NPI:1447479050
Name:MASCARENAS, RICK R (RPH)
Entity type:Individual
Prefix:MR
First Name:RICK
Middle Name:R
Last Name:MASCARENAS
Suffix:
Gender:M
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:P.O. BOX 1180
Mailing Address - Street 2:RANCHO SAN GABRIEL
Mailing Address - City:SAN JUAN PUEBLO
Mailing Address - State:NM
Mailing Address - Zip Code:87566-1180
Mailing Address - Country:US
Mailing Address - Phone:505-852-4280
Mailing Address - Fax:505-747-0429
Practice Address - Street 1:1610 N RIVERSIDE DR
Practice Address - Street 2:
Practice Address - City:ESPANOLA
Practice Address - State:NM
Practice Address - Zip Code:87532-8063
Practice Address - Country:US
Practice Address - Phone:505-852-4280
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-24
Last Update Date:2014-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM44711835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy