Individual
TIANNA GRACE SEVACHKO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2609 7TH ST, LAS VEGAS, NM 87701-4863
(505) 425-5242
Mailing address
2609 7TH ST, LAS VEGAS, NM 87701-4863
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
RP00008755
NM
Other
Enumeration date
08/29/2017
Last updated
08/29/2017
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