Healthcare Provider Details

I. General information

NPI: 1205117355
Provider Name (Legal Business Name): LEE EDWIN RENFRO PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/02/2011
Last Update Date: 09/02/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8910 HOLLY AVE NE
ALBUQUERQUE NM
87122-2947
US

IV. Provider business mailing address

8910 HOLLY AVE NE
ALBUQUERQUE NM
87122-2947
US

V. Phone/Fax

Practice location:
  • Phone: 505-796-0387
  • Fax: 505-796-0396
Mailing address:
  • Phone: 505-796-0387
  • Fax: 505-796-0396

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP00007677
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: