Healthcare Provider Details

I. General information

NPI: 1821506882
Provider Name (Legal Business Name): MICHAEL LEN TOON PHARMACIST
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/11/2018
Last Update Date: 01/11/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5400 GIBSON BLVD SE
ALBUQUERQUE NM
87108-4729
US

IV. Provider business mailing address

11620 WOODMAR LN NE
ALBUQUERQUE NM
87111-6517
US

V. Phone/Fax

Practice location:
  • Phone: 505-268-2030
  • Fax:
Mailing address:
  • Phone: 505-363-6464
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP00004915
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: