Individual
KELLYLYNNE FOREST
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CPHT
Contact information
Practice address
123 MADEIRA DR SE, ALBUQUERQUE, NM 87108-2963
(505) 262-1538
(505) 243-5342
Mailing address
10411 TOWNER AVE NE, ALBUQUERQUE, NM 87112-3060
(541) 250-2345
Taxonomy
Speciality
Code
Description
License number
State
183700000X
Pharmacy Technician
Primary
PT00013188
NM
183700000X
Pharmacy Technician
T066714
AZ
Other
Enumeration date
12/16/2020
Last updated
12/16/2020
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