Healthcare Provider Details

I. General information

NPI: 1750002424
Provider Name (Legal Business Name): SHERRY ANN MONTOYA RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/09/2022
Last Update Date: 09/09/2022
Certification Date: 09/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 SILER RD BLDG A
SANTA FE NM
87507-3540
US

IV. Provider business mailing address

2970 VIAJE PAVO REAL
SANTA FE NM
87505-5388
US

V. Phone/Fax

Practice location:
  • Phone: 505-412-0195
  • Fax:
Mailing address:
  • Phone: 505-670-5570
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License NumberPH00001608
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: