Healthcare Provider Details

I. General information

NPI: 1245237759
Provider Name (Legal Business Name): MICHAEL L MONSKE PHARM.D, PHC
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/30/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

530 W CORDOVA RD
SANTA FE NM
87505-1844
US

IV. Provider business mailing address

9132 VILLAGE AVE NE
ALBUQUERQUE NM
87122-2606
US

V. Phone/Fax

Practice location:
  • Phone: 505-820-1517
  • Fax:
Mailing address:
  • Phone: 505-831-7319
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPC00000115
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP00006678
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: