Healthcare Provider Details

I. General information

NPI: 1831655729
Provider Name (Legal Business Name): FARES SEMEZIER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/15/2019
Last Update Date: 06/17/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2050A 2ND ST SE
KIRTLAND AFB NM
87117-5522
US

IV. Provider business mailing address

2050A 2ND ST SE
KIRTLAND AFB NM
87117-5522
US

V. Phone/Fax

Practice location:
  • Phone: 505-846-3200
  • Fax:
Mailing address:
  • Phone: 505-846-3200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPS58284
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: