Healthcare Provider Details

I. General information

NPI: 1144453721
Provider Name (Legal Business Name): KIM T MACH RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/28/2009
Last Update Date: 08/28/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5001 MONTGOMERY PL NE
ALBUQUERQUE NM
87109
US

IV. Provider business mailing address

5001 MONTGOMERY PL NE
ALBUQUERQUE NM
87109
US

V. Phone/Fax

Practice location:
  • Phone: 505-881-5210
  • Fax: 505-872-2613
Mailing address:
  • Phone: 505-881-5210
  • Fax: 505-872-2613

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP00006597
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: