Healthcare Provider Details

I. General information

NPI: 1740543271
Provider Name (Legal Business Name): MARK A PADILLA RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/19/2012
Last Update Date: 06/19/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1712 SAINT MICHAELS DR
SANTA FE NM
87505-7617
US

IV. Provider business mailing address

1712 SAINT MICHAELS DR
SANTA FE NM
87505-7617
US

V. Phone/Fax

Practice location:
  • Phone: 505-471-7823
  • Fax:
Mailing address:
  • Phone: 505-471-7823
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number4016
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: