MEDICARE: PRINCELY-ROY NUNKA DIKUBA RPH

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
1	183500000X	Pharmacist	RP00009036	NM

General Provider Information

NPI Number	:	1427616747
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PRINCELY-ROY NUNKA DIKUBA RPH

Provider Business Mailing Address
First Line	:	1956 HIGHWAY 180 E
Second Line	:
City	:	SILVER CITY
State	:	NM
Zip	:	88061-7781
Country	:	US
Telephone Number	:	575-388-1909
Fax Number	:

Provider Business Practice Location Address
First Line	:	1956 HIGHWAY 180 E
Second Line	:
City	:	SILVER CITY
State	:	NM
Zip	:	88061-7781
Country	:	US
Telephone Number	:	575-388-1909
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/01/2019
Last Update Date	:	06/01/2019

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