Healthcare Provider Details

I. General information

NPI: 1669855698
Provider Name (Legal Business Name): KRYSTLE TAPIA PHARMD, PHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2015
Last Update Date: 07/05/2023
Certification Date: 07/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1131 UNIVERSITY BLVD NE STE G
ALBUQUERQUE NM
87102-1738
US

IV. Provider business mailing address

1131 UNIVERSITY BLVD NE STE G
ALBUQUERQUE NM
87102-1738
US

V. Phone/Fax

Practice location:
  • Phone: 505-272-2341
  • Fax: 505-272-8140
Mailing address:
  • Phone: 505-272-2341
  • Fax: 505-272-8140

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License NumberRP00008162
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License NumberPC00000249
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: