Healthcare Provider Details

I. General information

NPI: 1174908487
Provider Name (Legal Business Name): ALICIA MARQUARDT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2015
Last Update Date: 07/28/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2100 CARLISLE BLVD NE
ALBUQUERQUE NM
87110-3810
US

IV. Provider business mailing address

9251 SAN DIEGO AVE NE
ALBUQUERQUE NM
87122-3835
US

V. Phone/Fax

Practice location:
  • Phone: 505-265-3549
  • Fax:
Mailing address:
  • Phone: 505-250-4654
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP00008402
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: