Provider Demographics
NPI:1093019838
Name:GARCIA, RAENA COLLEEN (PHARM D)
Entity Type:Individual
Prefix:MRS
First Name:RAENA
Middle Name:COLLEEN
Last Name:GARCIA
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3100 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88001-1162
Mailing Address - Country:US
Mailing Address - Phone:575-525-0298
Mailing Address - Fax:575-525-0166
Practice Address - Street 1:3100 N MAIN ST
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88001-1162
Practice Address - Country:US
Practice Address - Phone:575-525-0298
Practice Address - Fax:575-525-0166
Is Sole Proprietor?:No
Enumeration Date:2011-01-10
Last Update Date:2011-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM7579183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist