Healthcare Provider Details

I. General information

NPI: 1457873903
Provider Name (Legal Business Name): GREGORY CARLSON HADLOCK PHARMD, PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/15/2017
Last Update Date: 07/15/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 SAN MATEO BLVD SE
ALBUQUERQUE NM
87108-5629
US

IV. Provider business mailing address

1333 WELLESLEY DR NE
ALBUQUERQUE NM
87106-1133
US

V. Phone/Fax

Practice location:
  • Phone: 505-262-1915
  • Fax:
Mailing address:
  • Phone: 801-706-9962
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License NumberRP00008568
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: