Basic Information
| Provider Information | |||||||||
| NPI: | 1639773229 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ABUCEJO | ||||||||
| FirstName: | MARIZ ABIGAIL | ||||||||
| MiddleName: | BUSLON | ||||||||
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| Credential: | PHARMD, RPH | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3440 S BRYANT BLVD | ||||||||
| Address2: | |||||||||
| City: | SAN ANGELO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 769039308 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 3440 S BRYANT BLVD | ||||||||
| Address2: | |||||||||
| City: | SAN ANGELO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 769039308 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3252766598 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/24/2020 | ||||||||
| LastUpdateDate: | 08/08/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 08/06/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 183500000X | 65623 | TX | Y | Pharmacy Service Providers | Pharmacist |
No ID Information.