Healthcare Provider Details

I. General information

NPI: 1821136573
Provider Name (Legal Business Name): DENISE A. NORMAN RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/02/2007
Last Update Date: 06/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

516 E. NIZHONI BLVD GALLUP INDIAN MEDICAL CENTER (GIMC)
GALLUP NM
87301
US

IV. Provider business mailing address

516 E. NIZHONI BLVD GALLUP INDIAN MEDICAL CENTER (GIMC)
GALLUP NM
87301
US

V. Phone/Fax

Practice location:
  • Phone: 505-722-1185
  • Fax: 505-726-8621
Mailing address:
  • Phone: 505-722-1185
  • Fax: 505-726-8621

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPHA3153
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: