Individual
MARYKAY JIMENEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
617 W 29TH ST, PUEBLO, CO 81008-1115
(719) 545-9634
Mailing address
13 ALTADENA DR, PUEBLO, CO 81005-2963
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
12980
CO
Other
Enumeration date
11/23/2011
Last updated
11/23/2011
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