Healthcare Provider Details

I. General information

NPI: 1962770453
Provider Name (Legal Business Name): YOLANDA P NEZ PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/12/2011
Last Update Date: 12/12/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CORNER OF ROUTE 12 & 7
FT DEFIANCE AZ
86504
US

IV. Provider business mailing address

PO BOX 2311
FORT DEFIANCE AZ
86504-2311
US

V. Phone/Fax

Practice location:
  • Phone: 928-729-8328
  • Fax:
Mailing address:
  • Phone: 928-729-8325
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP00007654
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: