Healthcare Provider Details

I. General information

NPI: 1043757347
Provider Name (Legal Business Name): EVA KAMIANOWSKI RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/24/2017
Last Update Date: 01/24/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3490 NORTHRISE DR
LAS CRUCES NM
88011-7295
US

IV. Provider business mailing address

1020 S TRIVIZ DR APT 503
LAS CRUCES NM
88001-4011
US

V. Phone/Fax

Practice location:
  • Phone: 575-382-9100
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP00008622
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: