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General NPI Number Information
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NPI Number | 1174908487
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Entity Type | Individual
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Provider Name | ALICIA MARQUARDT
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Gender | Female
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Dates
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Enumeration Date | 07/28/2015
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Last Update Date | 07/28/2015
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Provider Practice Location Address
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Address Line | 2100 CARLISLE BLVD NE
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City | ALBUQUERQUE
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State | NM
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Zip | 87110-3810
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Country | US
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Telephone | 505-265-3549
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Fax |
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Provider Business Mailing Address
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Address Line | 9251 SAN DIEGO AVE NE
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City | ALBUQUERQUE
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State | NM
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Zip | 87122-3835
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Country | US
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Telephone | 505-250-4654
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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 | RP00008402
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License Number State | NM
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