Individual
WILFRED CHAVEZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PHRAMACIST
Contact information
Practice address
701 DALIES AVE, BELEN, NM 87002-3617
(505) 864-7471
(505) 864-6535
Mailing address
701 DALIES AVE, BELEN, NM 87002-3617
(505) 864-7471
(505) 864-6535
Taxonomy
Speciality
Code
Description
License number
State
3336C0004X
Compounding Pharmacy
Primary
CS00208115
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CS00208115
LICENSE NUMBER
NM
Enumeration date
03/06/2007
Last updated
07/08/2007
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