Healthcare Provider Details

I. General information

NPI: 1194846543
Provider Name (Legal Business Name): DANA KAY PELLEGRINO PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/03/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 W ASH ST
DEMING NM
88030-4000
US

IV. Provider business mailing address

3210 N RIDGE CREST DR
SILVER CITY NM
88061-7246
US

V. Phone/Fax

Practice location:
  • Phone: 505-546-5850
  • Fax: 505-543-6906
Mailing address:
  • Phone: 505-534-0100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP6192
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: