Healthcare Provider Details

I. General information

NPI: 1922614619
Provider Name (Legal Business Name): TAYLOR SEGOVIA RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/18/2020
Last Update Date: 09/18/2020
Certification Date: 09/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2401 W 21ST ST
CLOVIS NM
88101-2006
US

IV. Provider business mailing address

136 CREST POINT DR
PORTALES NM
88130-9057
US

V. Phone/Fax

Practice location:
  • Phone: 575-769-7541
  • Fax:
Mailing address:
  • Phone: 575-309-9816
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP00009139
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: