Healthcare Provider Details

I. General information

NPI: 1508273616
Provider Name (Legal Business Name): AMANDA SANCHEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/21/2014
Last Update Date: 07/21/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 SAN MATEO BLVD SE
ALBUQUERQUE NM
87108-5629
US

IV. Provider business mailing address

301 SAN MATEO BLVD SE
ALBUQUERQUE NM
87108-5629
US

V. Phone/Fax

Practice location:
  • Phone: 505-262-1915
  • Fax: 505-268-0059
Mailing address:
  • Phone: 505-262-1915
  • Fax: 505-268-0059

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP00006683
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: