Healthcare Provider Details

I. General information

NPI: 1659229425
Provider Name (Legal Business Name): PRIMA BHAKTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/18/2026
Last Update Date: 03/18/2026
Certification Date: 03/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1941 SOUTHERN BLVD SE
RIO RANCHO NM
87124-3510
US

IV. Provider business mailing address

2824 ABETO LN SE
RIO RANCHO NM
87124-4159
US

V. Phone/Fax

Practice location:
  • Phone: 505-891-8186
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP00010456
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: