Healthcare Provider Details

I. General information

NPI: 1457875619
Provider Name (Legal Business Name): ALEXANDRA G MCCOMAS RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2017
Last Update Date: 07/31/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2711 N TELSHOR BLVD
LAS CRUCES NM
88011-8202
US

IV. Provider business mailing address

2711 N TELSHOR BLVD
LAS CRUCES NM
88011-8202
US

V. Phone/Fax

Practice location:
  • Phone: 575-521-7890
  • Fax: 575-521-7893
Mailing address:
  • Phone: 575-521-7890
  • Fax: 575-521-7893

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number00007262
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: