Healthcare Provider Details

I. General information

NPI: 1194324996
Provider Name (Legal Business Name): ASHLEY DAWN POWELL PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/22/2020
Last Update Date: 10/22/2020
Certification Date: 10/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

455 SAINT MICHAELS DR
SANTA FE NM
87505-7601
US

IV. Provider business mailing address

62A ENTRADA LA CIENEGA
SANTA FE NM
87507-4484
US

V. Phone/Fax

Practice location:
  • Phone: 505-913-5000
  • Fax:
Mailing address:
  • Phone: 505-980-6860
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP00009401
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: