Healthcare Provider Details

I. General information

NPI: 1982824876
Provider Name (Legal Business Name): NEW MEXICO DEPARTMENT OF HEALTH PHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/26/2007
Last Update Date: 09/21/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 SILER RD BUILDING A
SANTA FE NM
87507-3541
US

IV. Provider business mailing address

1301 SILER RD BUILDING A
SANTA FE NM
87507-3541
US

V. Phone/Fax

Practice location:
  • Phone: 505-476-8358
  • Fax: 505-424-3438
Mailing address:
  • Phone: 505-476-8358
  • Fax: 505-424-3438

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License NumberPH00001608
License Number StateNM

VIII. Authorized Official

Name: MRS. SONYA REYNE MIERA
Title or Position: PHARMACIST ADVANCED
Credential: R.PH.
Phone: 505-476-8354