Healthcare Provider Details

I. General information

NPI: 1518309228
Provider Name (Legal Business Name): KRISTI DIANE SPIES R.PH.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/23/2013
Last Update Date: 07/23/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 E LLANO ESTACADO BLVD
CLOVIS NM
88101-3780
US

IV. Provider business mailing address

1050 FM 1760
MULESHOE TX
79347-6354
US

V. Phone/Fax

Practice location:
  • Phone: 575-762-3848
  • Fax: 575-762-3840
Mailing address:
  • Phone: 806-925-6747
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number5980
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number36922
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: