Healthcare Provider Details

I. General information

NPI: 1033442397
Provider Name (Legal Business Name): CYNTHIA JO MCRAE R.PH.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/17/2009
Last Update Date: 09/17/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13701 ENCANTADO RD NE ATTN: PHARMACY
ALBUQUERQUE NM
87123-2275
US

IV. Provider business mailing address

13701 ENCANTADO RD NE ATTN: PHARMACY
ALBUQUERQUE NM
87123-2275
US

V. Phone/Fax

Practice location:
  • Phone: 505-727-5945
  • Fax: 505-727-9072
Mailing address:
  • Phone: 505-727-5945
  • Fax: 505-727-9072

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberR000006367
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: