Healthcare Provider Details

I. General information

NPI: 1982910840
Provider Name (Legal Business Name): AMYE ELIZABETH TAKACH PHARM D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/29/2010
Last Update Date: 08/29/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2709 PAN AMERICAN FWY NE STE G
ALBUQUERQUE NM
87107-1650
US

IV. Provider business mailing address

10901 TRANQUILO RD NE
ALBUQUERQUE NM
87111-6941
US

V. Phone/Fax

Practice location:
  • Phone: 505-341-4739
  • Fax:
Mailing address:
  • Phone: 505-263-0238
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP00007529
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: