Healthcare Provider Details

I. General information

NPI: 1184735680
Provider Name (Legal Business Name): DANA SPRINGER RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

516 NIZHONI BLVD
GALLUP NM
87301-5748
US

IV. Provider business mailing address

220 NIZHONI BLVD APT 36
GALLUP NM
87301-7112
US

V. Phone/Fax

Practice location:
  • Phone: 505-722-1185
  • Fax:
Mailing address:
  • Phone: 505-722-1185
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number043387
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: