1427180009 NPI number — SANDIA HEALTH CLINIC PHARMACY

Table of content: MS. ELIZABETH ELLEN D'ELIA M.ED., ATC (NPI 1629038344)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1427180009 NPI number — SANDIA HEALTH CLINIC PHARMACY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SANDIA HEALTH CLINIC PHARMACY
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1427180009
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/16/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 31001-0673
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PASADENA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91110-0675
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
481 SANDIA LOOP
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BERNALILLO
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
87004-7076
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
505-867-4487
Provider Business Practice Location Address Fax Number:
505-771-5126
Provider Enumeration Date:
03/10/2007

Additional Information

Authorized Official

Authorized Official Last Name:
SCHWEITZER
Authorized Official First Name:
PAMELA
Authorized Official Middle Name:
Authorized Official Title or Position:
IHS PHARMACY CONSULTANT
Authorized Official Telephone Number:
602-364-5277

Provider Taxonomy Codes

  • Taxonomy code: 3336C0002X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332800000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 10462 , issued by the state of ( NM ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3209295 . This is a "NCPDP PROVIDER IDENTIFICATION NUMBER" identifier . This identifiers is of the category "OTHER".
  • Identifier: H7890 , issued by the state of ( NM ) . This identifiers is of the category "MEDICAID".




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