Healthcare Provider Details

I. General information

NPI: 1851720478
Provider Name (Legal Business Name): KATHLEEN FERNANDEZ RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KATHLEEN FERNANDEZ RPH

II. Dates (important events)

Enumeration Date: 11/04/2013
Last Update Date: 11/04/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4201 RODEO RD
SANTA FE NM
87507-4837
US

IV. Provider business mailing address

4201 RODEO RD
SANTA FE NM
87507-4837
US

V. Phone/Fax

Practice location:
  • Phone: 505-471-0152
  • Fax:
Mailing address:
  • Phone: 505-471-0152
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP00005491
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: