Healthcare Provider Details

I. General information

NPI: 1386126670
Provider Name (Legal Business Name): JEFFREY TYLER STEWART PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/03/2018
Last Update Date: 09/03/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1550 S VALLEY DR
LAS CRUCES NM
88005-3110
US

IV. Provider business mailing address

5162 WILD BILL LN
LAS CRUCES NM
88011-6115
US

V. Phone/Fax

Practice location:
  • Phone: 575-523-6844
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP00008961
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: