Healthcare Provider Details

I. General information

NPI: 1649424516
Provider Name (Legal Business Name): PRESBYTERIAN HEALTHCARE SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/05/2008
Last Update Date: 11/05/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8300 CONSTITUTION NE BLDG D
ALBUQUERQUE NM
87110
US

IV. Provider business mailing address

1100 CENTRAL SE
ALBUQUERQUE NM
87102
US

V. Phone/Fax

Practice location:
  • Phone: 505-559-6508
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License NumberCL00010610
License Number StateNM

VIII. Authorized Official

Name: MATTHEW NAGY
Title or Position: PHARMACY DIRECTOR
Credential:
Phone: 505-841-1872