Healthcare Provider Details

I. General information

NPI: 1114353281
Provider Name (Legal Business Name): KATHRYNE MICHELLE DUNN PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2013
Last Update Date: 09/20/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1420 N RENAISSANCE BLVD NE
ALBUQUERQUE NM
87107-7008
US

IV. Provider business mailing address

1420 N RENAISSANCE BLVD NE
ALBUQUERQUE NM
87107-7008
US

V. Phone/Fax

Practice location:
  • Phone: 505-342-7148
  • Fax: 505-342-7166
Mailing address:
  • Phone: 505-342-7148
  • Fax: 505-342-7166

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP00007808
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: