Healthcare Provider Details

I. General information

NPI: 1477037810
Provider Name (Legal Business Name): DAVID ARCHULETA PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/21/2018
Last Update Date: 09/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11120 LOMAS BLVD NE
ALBUQUERQUE NM
87112-5582
US

IV. Provider business mailing address

11501 LA VISTA GRANDE DR NE
ALBUQUERQUE NM
87111-5778
US

V. Phone/Fax

Practice location:
  • Phone: 505-346-0193
  • Fax:
Mailing address:
  • Phone: 505-221-1778
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP00008987
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: