Healthcare Provider Details

I. General information

NPI: 1952667511
Provider Name (Legal Business Name): CAROLINE ASHLEY CHALVERUS PHARM.D., DAME DOULA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/09/2012
Last Update Date: 10/23/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6 PUEBLO DEL SOL 6 PUEBLO DEL SOL
ALAMOGORDO NM
88310-9706
US

IV. Provider business mailing address

6 PUEBLO DEL SOL YOUR BIRTH LLC
ALAMOGORDO NM
88310-9706
US

V. Phone/Fax

Practice location:
  • Phone: 702-588-3804
  • Fax:
Mailing address:
  • Phone: 702-588-3804
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number4739065-1701
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number1569
License Number StateAK
# 3
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number16443
License Number StateNV
# 4
Primary TaxonomyY
Taxonomy Code374J00000X
TaxonomyDoula
License NumberNA DAME CERTIFIED
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: