Healthcare Provider Details

I. General information

NPI: 1902114838
Provider Name (Legal Business Name): CHARLES MAINA GACHENGO PHARM D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/14/2010
Last Update Date: 09/14/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 W JOE HARVEY BLVD
HOBBS NM
88240-0815
US

IV. Provider business mailing address

3419 N DAL PASO ST APARTMENT 8C
HOBBS NM
88240-1519
US

V. Phone/Fax

Practice location:
  • Phone: 575-392-0053
  • Fax:
Mailing address:
  • Phone: 484-356-7876
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP00007532
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: