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General NPI Number Information
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NPI Number | 1750895876
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Entity Type | Individual
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Provider Name | ANSON MARDELL WHITTON RPH
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Gender | Male
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Dates
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Enumeration Date | 11/28/2017
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Last Update Date | 11/28/2017
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Provider Practice Location Address
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Address Line | 721 MECHEM DR STE B
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City | RUIDOSO
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State | NM
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Zip | 88345-6911
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Country | US
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Telephone | 575-630-1080
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Fax | 575-630-1083
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Provider Business Mailing Address
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Address Line | 721 MECHEM DR STE B
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City | RUIDOSO
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State | NM
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Zip | 88345-6911
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Country | US
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Telephone | 575-630-1080
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Fax | 575-630-1083
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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 | RP00008834
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License Number State | NM
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