Healthcare Provider Details

I. General information

NPI: 1083929301
Provider Name (Legal Business Name): APRIL M MOTT PHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: APRIL SHERARD

II. Dates (important events)

Enumeration Date: 08/11/2010
Last Update Date: 01/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

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

IV. Provider business mailing address

PO BOX 26666 PHS PROVIDER ENROLLMENT
ALBUQUERQUE NM
87125-6666
US

V. Phone/Fax

Practice location:
  • Phone: 505-724-7761
  • Fax:
Mailing address:
  • Phone: 505-923-6770
  • Fax: 505-923-5354

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP00005941
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License NumberPC62
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: