Healthcare Provider Details

I. General information

NPI: 1588097232
Provider Name (Legal Business Name): MAUREEN ELLEN ANDERSEN PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/16/2013
Last Update Date: 08/16/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4800 MCMAHON BLVD NW
ALBUQUERQUE NM
87114-5010
US

IV. Provider business mailing address

4800 MCMAHON BLVD NW
ALBUQUERQUE NM
87114-5010
US

V. Phone/Fax

Practice location:
  • Phone: 505-922-4303
  • Fax:
Mailing address:
  • Phone: 505-922-4303
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP8000
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: