MEDICARE: MRS. LORAYNE MARGARET MCCLESKEY R.PH.

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	RP00004492	NM

General Provider Information

NPI Number	:	1386964914
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LORAYNE MARGARET MCCLESKEY R.PH.

Provider Business Mailing Address
First Line	:	1445 WYOMING BLVD NE
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87112-3849
Country	:	US
Telephone Number	:	505-299-4496
Fax Number	:	505-299-7713

Provider Business Practice Location Address
First Line	:	1445 WYOMING BLVD NE
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87112-3849
Country	:	US
Telephone Number	:	505-299-4496
Fax Number	:	505-299-7713

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

Provider Enumeration Date	:	06/05/2010
Last Update Date	:	06/05/2010

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