Healthcare Provider Details

I. General information

NPI: 1760304943
Provider Name (Legal Business Name): KATRINA SELENA NESIBA PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2026
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 SAN PEDRO DR SE
ALBUQUERQUE NM
87108-5153
US

IV. Provider business mailing address

6732 AKADEMEIA LOOP NE
ALBUQUERQUE NM
87111-1002
US

V. Phone/Fax

Practice location:
  • Phone: 505-265-1711
  • Fax:
Mailing address:
  • Phone: 915-637-4352
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP00010489
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: