Healthcare Provider Details

I. General information

NPI: 1396146676
Provider Name (Legal Business Name): HEIDI SEGURA PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/05/2014
Last Update Date: 09/05/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9600 SAGE RD SW
ALBUQUERQUE NM
87121-6803
US

IV. Provider business mailing address

9600 SAGE RD SW
ALBUQUERQUE NM
87121-6803
US

V. Phone/Fax

Practice location:
  • Phone: 505-831-4023
  • Fax: 505-831-4030
Mailing address:
  • Phone: 505-831-4023
  • Fax: 505-831-4030

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP00007594
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: