Healthcare Provider Details

I. General information

NPI: 1386741247
Provider Name (Legal Business Name): KERRI CULLIGAN PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2006
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

307 COYOTE CANYON DR
GALLUP NM
87301-4500
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number24684
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: