Healthcare Provider Details

I. General information

NPI: 1457043713
Provider Name (Legal Business Name): LILLIAN IDA LOVATO RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LILLIAN CHESMORE

II. Dates (important events)

Enumeration Date: 05/24/2023
Last Update Date: 05/24/2023
Certification Date: 05/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2929 COORS BLVD NW STE 110
ALBUQUERQUE NM
87120-1272
US

IV. Provider business mailing address

2929 COORS BLVD NW STE 110
ALBUQUERQUE NM
87120-1272
US

V. Phone/Fax

Practice location:
  • Phone: 505-433-6357
  • Fax: 505-404-0264
Mailing address:
  • Phone: 505-433-6357
  • Fax: 505-404-0264

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP00006262
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: