Healthcare Provider Details

I. General information

NPI: 1073921748
Provider Name (Legal Business Name): SANDRA TEMPLETON-OLONA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/25/2014
Last Update Date: 07/25/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2266 WYOMING BLVD NE
ALBUQUERQUE NM
87112-2620
US

IV. Provider business mailing address

2266 WYOMING BLVD NE
ALBUQUERQUE NM
87112-2620
US

V. Phone/Fax

Practice location:
  • Phone: 505-323-2885
  • Fax:
Mailing address:
  • Phone: 505-323-2885
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number4625
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: