Active NPI
Marco Antonio Vidaurri, PHARMD
- Pharmacist
- Fort Defiance, AZ
National Provider Identifier
1891097481
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 48901
- Practice address
- Intersections N7 & N12
Fort Defiance, AZ 86504-0649 - Phone
- (928) 729-8328
- NPI assigned
- Dec 2, 2010
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 48901 | TX | Primary |
Addresses
Primary practice location
Intersections N7 & N12
Fort Defiance, AZ 86504-0649
Mailing address
PO Box 649
Fort Defiance, AZ 86504-0649
Phone (928) 729-8328
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Pharmacy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 48901 | TX | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1291248000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1291248000000",
"number": "1891097481",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 649",
"city": "FORT DEFIANCE",
"state": "AZ",
"postal_code": "865040649",
"telephone_number": "928-729-8328"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "INTERSECTIONS N7 & N12",
"city": "FORT DEFIANCE",
"state": "AZ",
"postal_code": "865040649",
"telephone_number": "928-729-8328"
}
],
"practiceLocations": [],
"basic": {
"last_name": "VIDAURRI",
"first_name": "MARCO",
"middle_name": "ANTONIO",
"name_prefix": "Dr.",
"credential": "PHARMD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2010-12-02",
"last_updated": "2010-12-02",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "TX",
"license": "48901",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fort Defiance, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 2, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.