Healthcare Provider Details

I. General information

NPI: 1326389669
Provider Name (Legal Business Name): GINA KAY O'HARA PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/12/2013
Last Update Date: 03/12/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1397 WEIMER RD
TAOS NM
87571-6253
US

IV. Provider business mailing address

1397 WEIMER RD
TAOS NM
87571-6253
US

V. Phone/Fax

Practice location:
  • Phone: 575-737-3377
  • Fax: 575-737-3339
Mailing address:
  • Phone: 575-737-3377
  • Fax: 575-737-3339

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number5752
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: