Healthcare Provider Details

I. General information

NPI: 1104159219
Provider Name (Legal Business Name): ALTAF KAUSAR FAROOQI PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

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

III. Provider practice location address

101 COORS BLVD NW
ALBUQUERQUE NM
87121-2016
US

IV. Provider business mailing address

8200 MOON RIDGE TRL NE
ALBUQUERQUE NM
87122-3651
US

V. Phone/Fax

Practice location:
  • Phone: 505-831-3137
  • Fax:
Mailing address:
  • Phone: 401-486-3433
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number7006
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: