Healthcare Provider Details

I. General information

NPI: 1346763893
Provider Name (Legal Business Name): LAURE MONTES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2017
Last Update Date: 03/07/2022
Certification Date: 03/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4932 EDWARDS DR NE
ALBUQUERQUE NM
87111-6905
US

IV. Provider business mailing address

4932 EDWARDS DR NE
ALBUQUERQUE NM
87111-6905
US

V. Phone/Fax

Practice location:
  • Phone: 575-937-8494
  • Fax:
Mailing address:
  • Phone: 575-937-8494
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP00008737
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: