Healthcare Provider Details

I. General information

NPI: 1689758344
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

500 WALTER ST NE SUITE 202
ALBUQUERQUE NM
87102-2534
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 505-727-2900
  • Fax: 505-727-2990
Mailing address:
  • Phone: 505-262-7861
  • Fax: 505-262-7592

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPH00002745
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