Individual
DR. MARCO ANTONIO VIDAURRI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHARMD
Contact information
Practice address
INTERSECTIONS N7 & N12, FORT DEFIANCE, AZ 86504-0649
(928) 729-8328
Mailing address
PO BOX 649, FORT DEFIANCE, AZ 86504-0649
(928) 729-8328
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
48901
TX
Other
Enumeration date
12/02/2010
Last updated
12/02/2010
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