Provider Demographics
NPI:1083843205
Name:FINCH, C. NORMAN JR (PHARMD)
Entity Type:Individual
Prefix:
First Name:C.
Middle Name:NORMAN
Last Name:FINCH
Suffix:JR
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 ROAD 6763
Mailing Address - Street 2:
Mailing Address - City:FRUITLAND
Mailing Address - State:NM
Mailing Address - Zip Code:87416-8102
Mailing Address - Country:US
Mailing Address - Phone:505-801-0825
Mailing Address - Fax:
Practice Address - Street 1:3000 E MAIN ST
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:NM
Practice Address - Zip Code:87402-7622
Practice Address - Country:US
Practice Address - Phone:505-327-0236
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-09
Last Update Date:2017-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMRP00006469183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist