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General NPI Number Information
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NPI Number | 1073425856
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Entity Type | Individual
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Provider Name | DEIDRE KRISTIN GREYEYES RPH
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Gender | Female
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Dates
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Enumeration Date | 09/17/2026
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Last Update Date | 09/17/2026
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Provider Practice Location Address
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Address Line | 815 N COLUMBINE ST
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City | BLOOMFIELD
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State | NM
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Zip | 87413-5010
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Country | US
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Telephone | 720-768-6408
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Fax |
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Provider Business Mailing Address
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Address Line | 815 N COLUMBINE ST
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City | BLOOMFIELD
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State | NM
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Zip | 87413-5010
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Country | US
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Telephone | 720-768-6408
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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 | RP00010431
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License Number State | NM
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