Healthcare Provider Details

I. General information

NPI: 1376221101
Provider Name (Legal Business Name): CARMELITA COCA PHARMD, PHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2023
Last Update Date: 03/05/2024
Certification Date: 03/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

465 SAINT MICHAELS DR STE 114
SANTA FE NM
87505-7621
US

IV. Provider business mailing address

2031 MUNIZ RD SW
ALBUQUERQUE NM
87105-6529
US

V. Phone/Fax

Practice location:
  • Phone: 505-913-5287
  • Fax: 505-913-4949
Mailing address:
  • Phone: 505-304-2340
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License NumberPC00000504
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: