Healthcare Provider Details

I. General information

NPI: 1285984534
Provider Name (Legal Business Name): ALEXIA LEAL PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/13/2012
Last Update Date: 09/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6000 COORS BLVD NW
ALBUQUERQUE NM
87120-2702
US

IV. Provider business mailing address

6000 COORS BLVD NW
ALBUQUERQUE NM
87120-2702
US

V. Phone/Fax

Practice location:
  • Phone: 505-899-0989
  • Fax:
Mailing address:
  • Phone: 505-899-0989
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP00007900
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: