Healthcare Provider Details

I. General information

NPI: 1184946626
Provider Name (Legal Business Name): INNA VOINICH PHARM D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/25/2010
Last Update Date: 02/25/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12000 STONE LAKE ROAD
DULCE NM
87528-0187
US

IV. Provider business mailing address

PO BOX 187
DULCE NM
87528-0187
US

V. Phone/Fax

Practice location:
  • Phone: 575-759-7250
  • Fax: 575-759-7288
Mailing address:
  • Phone: 575-759-7250
  • Fax: 575-759-7288

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number18451
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: