Healthcare Provider Details

I. General information

NPI: 1063353878
Provider Name (Legal Business Name): MARIAH BERNAL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2026
Last Update Date: 04/03/2026
Certification Date: 04/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3501 LOMAS BLVD NE
ALBUQUERQUE NM
87106-1335
US

IV. Provider business mailing address

13228 VELMA CT NE
ALBUQUERQUE NM
87112-6356
US

V. Phone/Fax

Practice location:
  • Phone: 505-255-8908
  • Fax: 505-255-5037
Mailing address:
  • Phone: 505-255-8908
  • Fax: 505-255-5037

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP00010435
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: