Healthcare Provider Details

I. General information

NPI: 1639450653
Provider Name (Legal Business Name): SHAUNA RACHELLE HOOVER PHARM.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/03/2011
Last Update Date: 09/03/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 UNSER BLVD NW
ALBUQUERQUE NM
87120-3889
US

IV. Provider business mailing address

2200 UNSER BLVD NW
ALBUQUERQUE NM
87120-3889
US

V. Phone/Fax

Practice location:
  • Phone: 505-217-9940
  • Fax: 505-217-9996
Mailing address:
  • Phone: 505-217-9940
  • Fax: 505-217-9996

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP00007526
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: