Healthcare Provider Details

I. General information

NPI: 1316564545
Provider Name (Legal Business Name): VISHAL KHOLWADWALA PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/04/2020
Last Update Date: 10/18/2022
Certification Date: 10/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2402 W PIERCE ST STE 2B
CARLSBAD NM
88220-3568
US

IV. Provider business mailing address

2402 W PIERCE ST STE 2B
CARLSBAD NM
88220-3568
US

V. Phone/Fax

Practice location:
  • Phone: 575-885-2979
  • Fax: 575-885-5714
Mailing address:
  • Phone: 575-885-2979
  • Fax: 575-885-5714

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP00009280
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: