Healthcare Provider Details

I. General information

NPI: 1720395932
Provider Name (Legal Business Name): ELISA GARCIA PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

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

III. Provider practice location address

7900 CENTRAL AVE NW
ALBUQUERQUE NM
87121-2147
US

IV. Provider business mailing address

1604 PONTIAC PL SW
ALBUQUERQUE NM
87105-7160
US

V. Phone/Fax

Practice location:
  • Phone: 505-833-7598
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP00007219
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: