Healthcare Provider Details

I. General information

NPI: 1285170787
Provider Name (Legal Business Name): DAISY ANTWI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/09/2017
Last Update Date: 01/09/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3800 N LOVINGTON HWY
HOBBS NM
88240-1033
US

IV. Provider business mailing address

3800 N LOVINGTON HWY
HOBBS NM
88240-1033
US

V. Phone/Fax

Practice location:
  • Phone: 575-492-0310
  • Fax: 575-492-0315
Mailing address:
  • Phone: 575-492-0310
  • Fax: 575-492-0315

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP00008649
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: