Healthcare Provider Details

I. General information

NPI: 1437600210
Provider Name (Legal Business Name): STACI NEWMAN PHARM D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/17/2016
Last Update Date: 02/05/2021
Certification Date: 02/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7103 4TH ST NW STE G
LOS RANCHOS NM
87107-6675
US

IV. Provider business mailing address

7103 4TH ST NW STE G
LOS RANCHOS NM
87107-6675
US

V. Phone/Fax

Practice location:
  • Phone: 505-358-7155
  • Fax: 866-333-9771
Mailing address:
  • Phone: 505-358-7155
  • Fax: 866-333-9771

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number6605
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: