Healthcare Provider Details

I. General information

NPI: 1235564394
Provider Name (Legal Business Name): STEPHANIE KATHERINE MONTOYA PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2013
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7105 CENTRAL AVE NE
ALBUQUERQUE NM
87108-2011
US

IV. Provider business mailing address

7105 CENTRAL AVE NE
ALBUQUERQUE NM
87108
US

V. Phone/Fax

Practice location:
  • Phone: 505-265-9027
  • Fax:
Mailing address:
  • Phone: 505-265-9027
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP00008021
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: