Healthcare Provider Details

I. General information

NPI: 1174607212
Provider Name (Legal Business Name): LOVELACE HEALTH SYSTEMS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/25/2006
Last Update Date: 03/19/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2121 JUAN TABO BLVD NE
ALBUQUERQUE NM
87112-3307
US

IV. Provider business mailing address

PO BOX 27803 ATTN: PHARMACY FINANCE
ALBUQUERQUE NM
87125-7803
US

V. Phone/Fax

Practice location:
  • Phone: 505-727-5925
  • Fax: 505-727-9071
Mailing address:
  • Phone: 505-262-7681
  • Fax: 505-262-7592

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPH00001694
License Number StateNM

VIII. Authorized Official

Name: BRAD TROM
Title or Position: CEO
Credential: RPH
Phone: 505-727-1299