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Individual

LOAN B HA

Active
Sole proprietor
No

Provider details

NPI number
Gender
F

Contact information

Practice address
7105 CENTRAL AVE NE, ALBUQUERQUE, NM 87108-2011
(505) 265-9027
(505) 265-4415
Mailing address
7412 DESERT EAGLE RD NE, ALBUQUERQUE, NM 87113-2284
(505) 363-3706

Taxonomy

Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
RP00007488
NM

Other

Enumeration date
08/22/2010
Last updated
08/22/2010
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