Healthcare Provider Details

I. General information

NPI: 1790599892
Provider Name (Legal Business Name): LISA NGUYEN RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/07/2025
Last Update Date: 02/07/2025
Certification Date: 02/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2101 NORTHERN BLVD NE
RIO RANCHO NM
87124-4727
US

IV. Provider business mailing address

595 TURMALINA DR SE
RIO RANCHO NM
87124-5086
US

V. Phone/Fax

Practice location:
  • Phone: 505-217-3980
  • Fax:
Mailing address:
  • Phone: 575-621-5157
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP00010276
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: