MEDICARE: KEISHLA MARIE CORTES VERA

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	00009325	NM

General Provider Information

NPI Number	:	1083212534
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KEISHLA MARIE CORTES VERA

Provider Business Mailing Address
First Line	:	7400 SAN PEDRO DR NE APT 1015
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87109-4688
Country	:	US
Telephone Number	:	939-225-0655
Fax Number	:

Provider Business Practice Location Address
First Line	:	7400 SAN PEDRO DR NE APT 1015
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87109-4688
Country	:	US
Telephone Number	:	939-225-0655
Fax Number	:

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

Provider Enumeration Date	:	10/15/2020
Last Update Date	:	10/15/2020

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