Healthcare Provider Details

I. General information

NPI: 1003048877
Provider Name (Legal Business Name): ROCHELLE FLIETHMAN PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2009
Last Update Date: 08/29/2023
Certification Date: 08/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4710 JEFFERSON ST NE
ALBUQUERQUE NM
87109-2155
US

IV. Provider business mailing address

1100 CENTRAL AVE SE PHARMACY ADMINISTRATION
ALBUQUERQUE NM
87106-4930
US

V. Phone/Fax

Practice location:
  • Phone: 505-955-9454
  • Fax: 505-888-9644
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number3222
License Number StateWY
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP00007203
License Number StateNM
# 3
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License NumberPC00000183
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: