Healthcare Provider Details

I. General information

NPI: 1881827335
Provider Name (Legal Business Name): MARTIN S MIERA RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/01/2009
Last Update Date: 09/01/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3100 N MAIN ST
LAS CRUCES NM
88001-1162
US

IV. Provider business mailing address

765 CREED AVE
LAS CRUCES NM
88005-1264
US

V. Phone/Fax

Practice location:
  • Phone: 575-525-0298
  • Fax: 575-525-0166
Mailing address:
  • Phone: 575-640-8650
  • Fax: 575-525-0166

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License NumberRP00004449
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: