Healthcare Provider Details

I. General information

NPI: 1447598651
Provider Name (Legal Business Name): SANDRA L ABEYTA RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/22/2013
Last Update Date: 01/22/2013
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

PO BOX 976
CHAMA NM
87520-0976
US

V. Phone/Fax

Practice location:
  • Phone: 505-899-0989
  • Fax:
Mailing address:
  • Phone: 575-756-4023
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP000005580
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: