Healthcare Provider Details

I. General information

NPI: 1700119906
Provider Name (Legal Business Name): MAHMOUD ABDELHAQ PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/08/2009
Last Update Date: 10/27/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11001 MENAUL BLVD NE
ALBUQUERQUE NM
87112-2432
US

IV. Provider business mailing address

11001 MENAUL BLVD NE
ALBUQUERQUE NM
87112-2432
US

V. Phone/Fax

Practice location:
  • Phone: 505-200-3440
  • Fax: 505-200-3436
Mailing address:
  • Phone: 505-200-3440
  • Fax: 505-200-3436

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP00007307
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License NumberRP00007307
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: