MEDICARE: THAO NELSON PHARMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1835P0018X	Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist	RP00008982	NM

General Provider Information

NPI Number	:	1003385139
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THAO NELSON PHARMD

Provider Business Mailing Address
First Line	:	200 TRAMWAY BLVD SE
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87123-3934
Country	:	US
Telephone Number	:	505-296-9751
Fax Number	:	505-271-9095

Provider Business Practice Location Address
First Line	:	200 TRAMWAY BLVD SE
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87123-3934
Country	:	US
Telephone Number	:	505-296-9751
Fax Number	:	505-271-9095

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/19/2018
Last Update Date	:	06/18/2026

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Directions to “ THAO NELSON PHARMD” Practice Location

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