Healthcare Provider Details

I. General information

NPI: 1679373559
Provider Name (Legal Business Name): MICHAEL JOHN NEVILLE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/18/2025
Last Update Date: 03/18/2025
Certification Date: 03/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6250 PASEO DEL NORTE NE
ALBUQUERQUE NM
87113-1712
US

IV. Provider business mailing address

13000 I40 WEST FRONTAGE RD NW
ALBUQUERQUE NM
87121-9024
US

V. Phone/Fax

Practice location:
  • Phone: 505-217-2392
  • Fax:
Mailing address:
  • Phone: 505-290-0671
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP00010301
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: