Healthcare Provider Details

I. General information

NPI: 1689885790
Provider Name (Legal Business Name): PHILEAN T APODACA CPHT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

209 SAN MATEO BLVD NE
ALBUQUERQUE NM
87108-1508
US

IV. Provider business mailing address

3901 MONTGOMERY BLVD NE APT 1202
ALBUQUERQUE NM
87109-1083
US

V. Phone/Fax

Practice location:
  • Phone: 505-262-1538
  • Fax:
Mailing address:
  • Phone: 505-269-9447
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number3201-0105-0750-866
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: