Healthcare Provider Details

I. General information

NPI: 1023202017
Provider Name (Legal Business Name): CHERYL A BURLETT M.S. PHARM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/01/2007
Last Update Date: 07/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3695 HOT SPRINGS BLVD
LAS VEGAS NM
87701-9549
US

IV. Provider business mailing address

3695 HOT SPRINGS BLVD
LAS VEGAS NM
87701-9549
US

V. Phone/Fax

Practice location:
  • Phone: 505-454-2183
  • Fax: 505-454-2182
Mailing address:
  • Phone: 505-454-2183
  • Fax: 505-454-2182

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License NumberRP00004930
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License NumberPC00000054
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: