Healthcare Provider Details

I. General information

NPI: 1922816016
Provider Name (Legal Business Name): ANA EDWARDS PHARMD
Entity Type: Individual
Gender:
Sole Proprietor: N

Provider Other Name: ANA OVALLE EDWARDS PHARMD

II. Dates (important events)

Enumeration Date: 12/20/2024
Last Update Date: 12/20/2024
Certification Date: 12/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 N SONOMA RANCH BLVD
LAS CRUCES NM
88011-1608
US

IV. Provider business mailing address

150 N SONOMA RANCH BLVD
LAS CRUCES NM
88011-1608
US

V. Phone/Fax

Practice location:
  • Phone: 575-323-6097
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP00010267
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: