Healthcare Provider Details

I. General information

NPI: 1316021066
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

5400 GIBSON BLVD SE
ALBUQUERQUE NM
87108-4729
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 505-727-5915
  • Fax: 505-727-1241
Mailing address:
  • Phone: 505-727-1281
  • Fax: 505-727-1245

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPH00001685
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State

VIII. Authorized Official

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