Healthcare Provider Details

I. General information

NPI: 1093020331
Provider Name (Legal Business Name): ALBERT PLATT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/11/2010
Last Update Date: 08/11/2010
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

1256 EL PASEO RD
LAS CRUCES NM
88001-6026
US

V. Phone/Fax

Practice location:
  • Phone: 575-525-8713
  • Fax:
Mailing address:
  • Phone: 575-525-8713
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP00007311
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: