Healthcare Provider Details

I. General information

NPI: 1750114799
Provider Name (Legal Business Name): BROOKE ASTON PHARMD.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/23/2024
Last Update Date: 08/23/2024
Certification Date: 08/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6100 PASEO DEL NORTE NE
ALBUQUERQUE NM
87113-1512
US

IV. Provider business mailing address

6100 PASEO DEL NORTE NE
ALBUQUERQUE NM
87113-1512
US

V. Phone/Fax

Practice location:
  • Phone: 505-346-0136
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP00010196
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: