Healthcare Provider Details

I. General information

NPI: 1063233302
Provider Name (Legal Business Name): KATHRYN MCNEIL RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/19/2024
Last Update Date: 10/19/2024
Certification Date: 10/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4950 MONTGOMERY BLVD NE
ALBUQUERQUE NM
87109-1306
US

IV. Provider business mailing address

512 NIAGARA RD NE
ALBUQUERQUE NM
87113-1014
US

V. Phone/Fax

Practice location:
  • Phone: 505-883-8706
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP00010243
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: