Healthcare Provider Details

I. General information

NPI: 1386312312
Provider Name (Legal Business Name): MERISSA BEGAY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/03/2021
Last Update Date: 09/03/2021
Certification Date: 09/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

511 W CORDOVA RD
SANTA FE NM
87505-1843
US

IV. Provider business mailing address

209 BONITO LN NW
LOS LUNAS NM
87031-8460
US

V. Phone/Fax

Practice location:
  • Phone: 505-983-5546
  • Fax:
Mailing address:
  • Phone: 505-818-8594
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP00009535
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: