Healthcare Provider Details

I. General information

NPI: 1508969718
Provider Name (Legal Business Name): MICHEL B DISCO RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/06/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2005 WHITE CLOUD ST NE
ALBUQUERQUE NM
87112-3716
US

IV. Provider business mailing address

2005 WHITE CLOUD ST NE
ALBUQUERQUE NM
87112-3716
US

V. Phone/Fax

Practice location:
  • Phone: 505-385-7296
  • Fax:
Mailing address:
  • Phone: 505-385-7296
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number3779
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: