Healthcare Provider Details

I. General information

NPI: 1942536685
Provider Name (Legal Business Name): LOUANN C BRANCH PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/01/2009
Last Update Date: 08/03/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8205 SLEEPING BEAR DR NW
ALBUQUERQUE NM
87120-2894
US

IV. Provider business mailing address

8736 E. BROADWAY BLVD
TUCSON AZ
85710
US

V. Phone/Fax

Practice location:
  • Phone: 480-555-5555
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP00006704
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: