Healthcare Provider Details

I. General information

NPI: 1265722169
Provider Name (Legal Business Name): AIMEE CATHERINE CRAVEN REINHARD PHARM D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/12/2011
Last Update Date: 04/12/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

516 E NIZHONI BLVD
GALLUP NM
87301
US

IV. Provider business mailing address

516 E NIZHONI BLVD
GALLUP NM
87301
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 TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH025822
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License NumberRPH025822
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: