Healthcare Provider Details

I. General information

NPI: 1962646265
Provider Name (Legal Business Name): LOVELACE HEALTH SYSTEMS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/30/2009
Last Update Date: 03/19/2014
Certification Date:
Deactivation Date: 11/09/2011
Reactivation Date: 11/22/2011

III. Provider practice location address

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

IV. Provider business mailing address

PO BOX 27803 PHARMACY FINANCE
ALBUQUERQUE NM
87125-7803
US

V. Phone/Fax

Practice location:
  • Phone: 505-727-1299
  • Fax: 505-727-2990
Mailing address:
  • Phone: 505-727-1273
  • Fax: 505-727-7439

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License NumberPH00003167
License Number StateNM

VIII. Authorized Official

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