Healthcare Provider Details

I. General information

NPI: 1619856408
Provider Name (Legal Business Name): MAHYA SHOJAEE PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/27/2025
Last Update Date: 08/27/2025
Certification Date: 08/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

151 S WALNUT ST SUITE 3A5
LAS CRUCES NM
88001
US

IV. Provider business mailing address

151 S WALNUT ST SUITE 3A5
LAS CRUCES NM
88001
US

V. Phone/Fax

Practice location:
  • Phone: 575-288-1412
  • Fax:
Mailing address:
  • Phone: 575-288-1412
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP00010262
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: