Individual
GRANT SUDHOLT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
RPH
Contact information
Practice address
66 STATE ROAD 344, EDGEWOOD, NM 87015-6849
(505) 286-3053
Mailing address
PO BOX 1673, SANDIA PARK, NM 87047-1673
(505) 710-3452
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
RP6453
NM
Other
Enumeration date
08/08/2014
Last updated
08/08/2014
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