Healthcare Provider Details

I. General information

NPI: 1639996002
Provider Name (Legal Business Name): GLORIA SELENE BURCIAGA PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/25/2024
Last Update Date: 09/25/2024
Certification Date: 09/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1256 EL PASEO RD
LAS CRUCES NM
88001-6026
US

IV. Provider business mailing address

PO BOX 1605
ANTHONY NM
88021-1605
US

V. Phone/Fax

Practice location:
  • Phone: 575-525-8713
  • Fax:
Mailing address:
  • Phone: 915-525-2686
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP00010229
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: