Healthcare Provider Details

I. General information

NPI: 1023341377
Provider Name (Legal Business Name): LYNDA CAROLINE RALSTON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/17/2009
Last Update Date: 09/17/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1256 EL PASEO RD
LAS CRUCES NM
88001-6026
US

IV. Provider business mailing address

5155 ALAMO MINE TRL
LAS CRUCES NM
88011-9305
US

V. Phone/Fax

Practice location:
  • Phone: 575-525-8713
  • Fax: 575-541-8561
Mailing address:
  • Phone: 575-521-1573
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number6849
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: