Healthcare Provider Details

I. General information

NPI: 1356641393
Provider Name (Legal Business Name): ANDREA TONYA PARRA RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/25/2010
Last Update Date: 10/25/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8100 WYOMING BLVD NE STE A
ALBUQUERQUE NM
87113-1947
US

IV. Provider business mailing address

3727 LINDA VISTA AVE NE
RIO RANCHO NM
87124-4192
US

V. Phone/Fax

Practice location:
  • Phone: 505-857-9783
  • Fax: 505-857-9835
Mailing address:
  • Phone: 505-453-4378
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP00006655
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: