Healthcare Provider Details

I. General information

NPI: 1730014671
Provider Name (Legal Business Name): SCOTT MICHAEL KERSHAW PHARM.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2026
Last Update Date: 06/13/2026
Certification Date: 06/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2400 UNSER BLVD SE
RIO RANCHO NM
87124-3392
US

IV. Provider business mailing address

1829 TERRA DE SOL DR SE
RIO RANCHO NM
87124-8864
US

V. Phone/Fax

Practice location:
  • Phone: 505-253-7501
  • Fax:
Mailing address:
  • Phone: 406-274-2931
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPHA-PHA-LIC-7728
License Number StateMT
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP00009121
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: