Healthcare Provider Details

I. General information

NPI: 1316052004
Provider Name (Legal Business Name): CARRIE EDSITTY PHARM D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CARRIE ARVISO

II. Dates (important events)

Enumeration Date: 08/20/2006
Last Update Date: 02/24/2022
Certification Date: 02/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

TOHATCHI HEALTH CENTER 07 CHOOSHGAI DRIVE
TOHATCHI NM
87325
US

IV. Provider business mailing address

TOHATCHI HEALTH CENTER 07 CHOOSHGAI DRIVE PO BOX 142
TOHATCHI NM
87325
US

V. Phone/Fax

Practice location:
  • Phone: 505-733-8218
  • Fax: 505-733-2384
Mailing address:
  • Phone: 505-733-8218
  • Fax: 505-733-2384

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number6652
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: