Individual
DUSTIN MAYBERRY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHARMD
Contact information
Practice address
4404 BARRETT AVE NW, ALBUQUERQUE, NM 87114-6529
(575) 956-5114
Mailing address
4404 BARRETT AVE NW, ALBUQUERQUE, NM 87114-6529
(575) 956-5114
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
RP00009299
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
RP00009299
NMBOP
NM
Enumeration date
08/10/2020
Last updated
11/23/2020
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