Healthcare Provider Details

I. General information

NPI: 1417628694
Provider Name (Legal Business Name): VICTORIA E. GUTIERREZ DOCTOR OF PHARMACY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/27/2021
Last Update Date: 09/27/2021
Certification Date: 09/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 6TH ST N
SOCORRO NM
87801-4242
US

IV. Provider business mailing address

PO BOX 1443
SOCORRO NM
87801-1443
US

V. Phone/Fax

Practice location:
  • Phone: 575-838-1426
  • Fax:
Mailing address:
  • Phone: 505-660-6919
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP00009566
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: