Healthcare Provider Details

I. General information

NPI: 1104804616
Provider Name (Legal Business Name): MARIA KLEMENT DAHLKE PHARMD, PC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/04/2006
Last Update Date: 09/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 N WASHINGTON AVE
ROSWELL NM
88201-3066
US

IV. Provider business mailing address

300 N WASHINGTON AVE
ROSWELL NM
88201-3066
US

V. Phone/Fax

Practice location:
  • Phone: 619-200-5205
  • Fax:
Mailing address:
  • Phone: 619-200-5205
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number10160
License Number StateNE
# 2
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License NumberPC00000187
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: