Healthcare Provider Details

I. General information

NPI: 1770106486
Provider Name (Legal Business Name): ABUNDANT LOVE HEALTH CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/28/2020
Last Update Date: 05/28/2020
Certification Date: 05/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2921 CARLISLE BLVD NE
ALBUQUERQUE NM
87110-2865
US

IV. Provider business mailing address

PO BOX 92468
ALBUQUERQUE NM
87199-2468
US

V. Phone/Fax

Practice location:
  • Phone: 505-832-7162
  • Fax:
Mailing address:
  • Phone: 505-832-7162
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P2201X
TaxonomyAmbulatory Care Pharmacist
License Number
License Number State

VIII. Authorized Official

Name: DR. IFEOMA ACHUSIM
Title or Position: CEO
Credential: PHARMACIST
Phone: 505-832-7162