Healthcare Provider Details

I. General information

NPI: 1912514803
Provider Name (Legal Business Name): KENG MAN WAI PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/25/2020
Last Update Date: 10/24/2023
Certification Date: 10/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2401 S CANAL ST
CARLSBAD NM
88220-6523
US

IV. Provider business mailing address

2610 MOUNTAIN VIEW DR APT C
CARLSBAD NM
88220-3201
US

V. Phone/Fax

Practice location:
  • Phone: 575-885-1029
  • Fax:
Mailing address:
  • Phone: 505-652-8899
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP00009353
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: