Healthcare Provider Details

I. General information

NPI: 1326843087
Provider Name (Legal Business Name): AUDREY DETTWILLER PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/17/2025
Last Update Date: 02/17/2025
Certification Date: 02/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8915 HILTON AVE NE
ALBUQUERQUE NM
87111-3123
US

IV. Provider business mailing address

8915 HILTON AVE NE
ALBUQUERQUE NM
87111-3123
US

V. Phone/Fax

Practice location:
  • Phone: 505-908-5687
  • Fax:
Mailing address:
  • Phone: 505-908-5687
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP00008753
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: