Healthcare Provider Details

I. General information

NPI: 1679677900
Provider Name (Legal Business Name): ABEYTA ENTERPRISES INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/08/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

612 S. TERRACE AVE.
CHAMA NM
87520-0976
US

IV. Provider business mailing address

PO BOX 976
CHAMA NM
87520-0976
US

V. Phone/Fax

Practice location:
  • Phone: 505-756-2131
  • Fax: 505-756-2885
Mailing address:
  • Phone: 505-756-2131
  • Fax: 505-756-2885

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP00005580
License Number StateNM

VIII. Authorized Official

Name: MR. NICK D. ABEYTA
Title or Position: OWNER/MGR
Credential:
Phone: 505-756-2131