Healthcare Provider Details

I. General information

NPI: 1275463564
Provider Name (Legal Business Name): MARY SJOBERG RPH
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2026
Last Update Date: 05/20/2026
Certification Date: 05/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

199 HWY 50
PECOS NM
87552
US

IV. Provider business mailing address

PO BOX 710
PECOS NM
87552-0710
US

V. Phone/Fax

Practice location:
  • Phone: 505-443-3211
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP00004579
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: