Healthcare Provider Details

I. General information

NPI: 1639976616
Provider Name (Legal Business Name): MARY TRAN YOUNG PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/27/2025
Last Update Date: 02/27/2025
Certification Date: 02/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2211 LOMAS BLVD NE
ALBUQUERQUE NM
87106-2719
US

IV. Provider business mailing address

4036 GONDOLA WAY NE
ALBUQUERQUE NM
87113-2484
US

V. Phone/Fax

Practice location:
  • Phone: 505-272-1700
  • Fax:
Mailing address:
  • Phone: 512-968-6353
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835X0200X
TaxonomyOncology Pharmacist
License NumberRP00009285
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: