=====================================================
General NPI Number Information
=====================================================
NPI Number | 1235947805
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ABIGAIL TREZISE PHARMD, BCOP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/27/2024
-----------------------------------------------------
Last Update Date | 12/27/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1501 SAN PEDRO DR SE
-----------------------------------------------------
City | ALBUQUERQUE
-----------------------------------------------------
State | NM
-----------------------------------------------------
Zip | 87108-5153
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 505-265-1711
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7 TEJON DR
-----------------------------------------------------
City | TIJERAS
-----------------------------------------------------
State | NM
-----------------------------------------------------
Zip | 87059-7418
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 585-705-0218
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1835X0200X
-----------------------------------------------------
Taxonomy Name | Oncology Pharmacist
-----------------------------------------------------
License Number | RP00008999
-----------------------------------------------------
License Number State | NM
-----------------------------------------------------