Healthcare Provider Details

I. General information

NPI: 1568867448
Provider Name (Legal Business Name): AMBER GALLEGOS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/04/2014
Last Update Date: 11/04/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4127 7TH ST NW
ALBUQUERQUE NM
87107-3503
US

IV. Provider business mailing address

4127 7TH ST NW
ALBUQUERQUE NM
87107-3503
US

V. Phone/Fax

Practice location:
  • Phone: 505-977-9564
  • Fax:
Mailing address:
  • Phone: 505-977-9564
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP00008080
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: