MEDICARE: MIN BAE

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	183500000X	Pharmacist	RP00007969	NM

General Provider Information

NPI Number	:	1023482585
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MIN BAE

Provider Business Mailing Address
First Line	:	2175 SEDONA HILLS PKWY
Second Line	:
City	:	LAS CRUCES
State	:	NM
Zip	:	88011-4135
Country	:	US
Telephone Number	:	217-390-4513
Fax Number	:

Provider Business Practice Location Address
First Line	:	1900 BATAAN MEMORIAL E # LC
Second Line	:
City	:	LAS CRUCES
State	:	NM
Zip	:	88011-6011
Country	:	US
Telephone Number	:	575-522-8603
Fax Number	:

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

Provider Enumeration Date	:	11/20/2015
Last Update Date	:	11/20/2015

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Directions to “ MIN BAE ” Practice Location

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