Healthcare Provider Details

I. General information

NPI: 1205048220
Provider Name (Legal Business Name): DR. TRACIE ANNE GALINDO I
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4700 TRAMWAY BLVD
ALBUQUERQUE NM
87111
US

IV. Provider business mailing address

8824 HENRIETTE WYETH DR. NE
ALBUQUERQUE NM
87122
US

V. Phone/Fax

Practice location:
  • Phone: 505-292-5888
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP6784
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: