Healthcare Provider Details

I. General information

NPI: 1659689438
Provider Name (Legal Business Name): SAMUEL GENE CURRENCE JR. RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/15/2010
Last Update Date: 09/15/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4700 TRAMWAY BLVD NE
ALBUQUERQUE NM
87111-2979
US

IV. Provider business mailing address

4700 TRAMWAY BLVD NE
ALBUQUERQUE NM
87111-2979
US

V. Phone/Fax

Practice location:
  • Phone: 505-292-5888
  • Fax:
Mailing address:
  • Phone: 505-292-5888
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number5740
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: