Healthcare Provider Details

I. General information

NPI: 1093320368
Provider Name (Legal Business Name): MICHAELA GALLEGOS PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/13/2020
Last Update Date: 02/23/2022
Certification Date: 02/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5850 EUBANK BLVD NE
ALBUQUERQUE NM
87111
US

IV. Provider business mailing address

5850 EUBANK BLVD NE
ALBUQUERQUE NM
87111
US

V. Phone/Fax

Practice location:
  • Phone: 505-299-7621
  • Fax: 505-296-8225
Mailing address:
  • Phone: 505-299-7621
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP00009368
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: