Healthcare Provider Details

I. General information

NPI: 1659388007
Provider Name (Legal Business Name): MICHAEL CHANTZ EYRING PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/01/2006
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 E 20TH ST
FARMINGTON NM
87401-4204
US

IV. Provider business mailing address

4900 KINGSWAY DR
FARMINGTON NM
87402-4861
US

V. Phone/Fax

Practice location:
  • Phone: 505-326-3342
  • Fax: 505-325-4694
Mailing address:
  • Phone: 505-325-1299
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP00006206
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberPC-00000101
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: