Healthcare Provider Details

I. General information

NPI: 1457786782
Provider Name (Legal Business Name): JC THOMAS LOVELACE RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/05/2013
Last Update Date: 09/05/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 COORS BLVD NW
ALBUQUERQUE NM
87121-2006
US

IV. Provider business mailing address

111 COORS BLVD NW
ALBUQUERQUE NM
87121-2006
US

V. Phone/Fax

Practice location:
  • Phone: 505-836-5322
  • Fax: 505-839-4454
Mailing address:
  • Phone: 505-836-5322
  • Fax: 505-839-4454

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP00007989
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: