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General NPI Number Information
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NPI Number | 1649947433
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Entity Type | Individual
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Provider Name | MICHAEL RICHARD PETRICH PHARM.D.
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Gender | Male
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Dates
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Enumeration Date | 08/27/2021
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Last Update Date | 08/27/2021
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Provider Practice Location Address
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Address Line | 1501 SAN PEDRO DR SE
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City | ALBUQUERQUE
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State | NM
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Zip | 87108-5153
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Country | US
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Telephone | 505-265-1711
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Fax |
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Provider Business Mailing Address
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Address Line | 7400 SAN PEDRO DR NE APT 3011
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City | ALBUQUERQUE
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State | NM
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Zip | 87109-4698
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Country | US
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Telephone | 651-587-2862
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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 | PHA.0023664
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License Number State | CO
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