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NPI Code Detail

MEDICARE: DR. ELIZABETH MARIE ARCHULETA PHARM.D.

MEDICARE: DR. ELIZABETH MARIE ARCHULETA PHARM.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1183500000XPharmacistRP00008609NM

General Provider Information

NPI Number : 1255881462
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. ELIZABETH MARIE ARCHULETA PHARM.D.
Provider Business Mailing Address
First Line : 620 MILLS AVE
Second Line :
City : LAS VEGAS
State : NM
Zip : 87701-4671
Country : US
Telephone Number : 505-425-3317
Fax Number :
Provider Business Practice Location Address
First Line : 620 MILLS AVE
Second Line :
City : LAS VEGAS
State : NM
Zip : 87701-4671
Country : US
Telephone Number : 505-425-3317
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/12/2016
Last Update Date : 10/12/2016

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