Healthcare Provider Details

I. General information

NPI: 1801460639
Provider Name (Legal Business Name): BRITTANY LUNDGREN PHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2021
Last Update Date: 01/05/2024
Certification Date: 01/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3001 BROADMOOR BLVD NE
RIO RANCHO NM
87144-2100
US

IV. Provider business mailing address

10312 AMATISTA ST NW
ALBUQUERQUE NM
87114-5537
US

V. Phone/Fax

Practice location:
  • Phone: 505-994-7397
  • Fax: 505-994-7056
Mailing address:
  • Phone: 505-977-5967
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License NumberPC00000323
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: