Healthcare Provider Details

I. General information

NPI: 1427971951
Provider Name (Legal Business Name): MICHELLE K HO
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/01/2026
Last Update Date: 08/01/2026
Certification Date: 08/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

516 E NIZHONI BLVD
GALLUP NM
87301-5748
US

IV. Provider business mailing address

3009 W HISTORIC HIGHWAY 66 APT 120
GALLUP NM
87301-6813
US

V. Phone/Fax

Practice location:
  • Phone: 505-722-1170
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number2381129
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: