Healthcare Provider Details

I. General information

NPI: 1891004446
Provider Name (Legal Business Name): JOHN M GIVENS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/30/2010
Last Update Date: 09/30/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6125 4TH ST NW
ALBUQUERQUE NM
87107-5755
US

IV. Provider business mailing address

6704 MARIPOSA PL NW
ALBUQUERQUE NM
87120-3080
US

V. Phone/Fax

Practice location:
  • Phone: 505-344-3509
  • Fax:
Mailing address:
  • Phone: 505-289-9832
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number5288
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: