Healthcare Provider Details

I. General information

NPI: 1124500020
Provider Name (Legal Business Name): YASMINE AWAD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/06/2018
Last Update Date: 09/06/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11825 LOMAS BLVD NE
ALBUQUERQUE NM
87112-5613
US

IV. Provider business mailing address

1200 SASEBO ST NE
ALBUQUERQUE NM
87112-6328
US

V. Phone/Fax

Practice location:
  • Phone: 505-293-9156
  • Fax:
Mailing address:
  • Phone: 505-508-7735
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP00008979
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: