Healthcare Provider Details

I. General information

NPI: 1376201731
Provider Name (Legal Business Name): ASHLEY SANCHEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/02/2021
Last Update Date: 12/02/2021
Certification Date: 12/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4801 BECKNER RD
SANTA FE NM
87507-3641
US

IV. Provider business mailing address

PO BOX 606
ALGODONES NM
87001-0606
US

V. Phone/Fax

Practice location:
  • Phone: 505-772-1022
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP00009154
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: