Healthcare Provider Details

I. General information

NPI: 1114320132
Provider Name (Legal Business Name): ALICIA M GARDNER PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ALICIA M ARGUELLES PHARMD

II. Dates (important events)

Enumeration Date: 10/04/2014
Last Update Date: 10/04/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 ROBERT RD
GRANTS NM
87020-4012
US

IV. Provider business mailing address

PO BOX 66663
ALBUQUERQUE NM
87193-6663
US

V. Phone/Fax

Practice location:
  • Phone: 505-285-3378
  • Fax:
Mailing address:
  • Phone: 505-620-2354
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP00008002
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: