Healthcare Provider Details

I. General information

NPI: 1922437409
Provider Name (Legal Business Name): LOVELACE HEALTH SYSTEM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/05/2013
Last Update Date: 11/12/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9501 PASEO DEL NORTE NE STE C
ALBUQUERQUE NM
87122-2998
US

IV. Provider business mailing address

5400 GIBSON BLVD SE
ALBUQUERQUE NM
87108-4729
US

V. Phone/Fax

Practice location:
  • Phone: 505-727-1299
  • Fax:
Mailing address:
  • Phone: 505-727-1299
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: ANDREW KURTZ
Title or Position: DIRECTOR OF OPERATIONS
Credential: PHARM D
Phone: 505-206-3949