Healthcare Provider Details

I. General information

NPI: 1609278852
Provider Name (Legal Business Name): LARRY J. PINEDA PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/18/2014
Last Update Date: 03/13/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 ENCINO PL NE BUILDING F
ALBUQUERQUE NM
87102-2612
US

IV. Provider business mailing address

1 UNIVERSITY OF NEW MEXICO MSC09 5360
ALBUQUERQUE NM
87131-0001
US

V. Phone/Fax

Practice location:
  • Phone: 505-272-1312
  • Fax: 505-272-2240
Mailing address:
  • Phone: 505-925-2414
  • Fax: 505-272-6749

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP00007873
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License NumberPC00000239
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: