Healthcare Provider Details

I. General information

NPI: 1053510891
Provider Name (Legal Business Name): LOVELACE PHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/12/2007
Last Update Date: 07/12/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13701 ENCANTADO RD NE
ALBUQUERQUE NM
87123-2275
US

IV. Provider business mailing address

4201 ROMA AVE NE
ALBUQUERQUE NM
87108-1133
US

V. Phone/Fax

Practice location:
  • Phone: 505-237-8762
  • Fax: 505-237-8701
Mailing address:
  • Phone: 505-268-2109
  • Fax: 505-237-8701

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License NumberRP00006057
License Number StateNM

VIII. Authorized Official

Name: MRS. CLAIRE SUZANNE SEELINGER
Title or Position: PHARMACIST
Credential: RPH
Phone: 505-268-2109