Healthcare Provider Details

I. General information

NPI: 1861852808
Provider Name (Legal Business Name): REGINA CHI PHARM D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: REGINA CHILUM AMBE PHARM D

II. Dates (important events)

Enumeration Date: 03/03/2016
Last Update Date: 03/03/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1820 UNSER BLVD NW
ALBUQUERQUE NM
87120
US

IV. Provider business mailing address

1820 UNSER BLVD NW
ALBUQUERQUE NM
87120
US

V. Phone/Fax

Practice location:
  • Phone: 505-600-4292
  • Fax: 505-600-4291
Mailing address:
  • Phone: 505-600-4292
  • Fax: 505-600-4291

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP00008374
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: