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NPI Code Detail

MEDICARE: MRS. KELLY JO HADDAD PHARMD

MEDICARE: MRS. KELLY JO HADDAD 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
1183500000XPharmacistRP00006986NM

General Provider Information

NPI Number : 1134312135
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. KELLY JO HADDAD PHARMD
Provider Business Mailing Address
First Line : 5104 RIVER RIDGE PL NW
Second Line :
City : ALBUQUERQUE
State : NM
Zip : 87114-1231
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 4105 SOUTHERN BLVD SE
Second Line :
City : RIO RANCHO
State : NM
Zip : 87124-2069
Country : US
Telephone Number : 505-892-6690
Fax Number : 505-892-8244
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/22/2007
Last Update Date : 08/22/2007

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Directions to “ MRS. KELLY JO HADDAD PHARMD” Practice Location

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