Individual
LYDIA KAKUZE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1604 E SPRUCE ST, PORTALES, NM 88130-9489
(575) 359-3435
(575) 359-3431
Mailing address
1604 E SPRUCE ST, PORTALES, NM 88130-9489
(575) 359-3435
(575) 359-3431
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
RP00008650
NM
183500000X
Pharmacist
S022289
AZ
Other
Enumeration date
01/25/2017
Last updated
01/25/2017
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