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General NPI Number Information
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NPI Number | 1013317189
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Entity Type | Individual
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Provider Name | MICHELLE RENEE WITTENMYER PHARMD
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Gender | Female
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Dates
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Enumeration Date | 08/26/2014
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Last Update Date | 10/23/2018
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Provider Practice Location Address
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Address Line | 315 N MAIN ST
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City | BELEN
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State | NM
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Zip | 87002-3715
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Country | US
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Telephone | 505-861-1762
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Fax | 505-864-6998
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Provider Business Mailing Address
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Address Line | 6605 4TH ST NW
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City | LOS RANCHOS DE ALBUQUERQUE
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State | NM
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Zip | 87107
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Country | US
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Telephone | 505-345-9059
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | RP00008240
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License Number State | NM
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