Healthcare Provider Details

I. General information

NPI: 1801919774
Provider Name (Legal Business Name): ALLEN EDWARD PLYMALE PHC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/07/2007
Last Update Date: 05/08/2023
Certification Date: 05/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

122 S GOLD AVE STE 3
DEMING NM
88030-3755
US

IV. Provider business mailing address

1415 S COPPER
DEMING NM
88030-5010
US

V. Phone/Fax

Practice location:
  • Phone: 575-544-7280
  • Fax: 575-544-7281
Mailing address:
  • Phone: 575-544-7507
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPC 48
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License NumberPC00000048
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: