Healthcare Provider Details

I. General information

NPI: 1558286773
Provider Name (Legal Business Name): STEVANA OLIVAS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/13/2026
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10800 UNSER BLVD NW
ALBUQUERQUE NM
87114-1064
US

IV. Provider business mailing address

10800 UNSER BLVD NW
ALBUQUERQUE NM
87114-1064
US

V. Phone/Fax

Practice location:
  • Phone: 505-205-1849
  • Fax:
Mailing address:
  • Phone: 505-205-1849
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP00010503
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: