Provider Demographics
NPI:1114320132
Name:GARDNER, ALICIA M (PHARMD)
Entity Type:Individual
Prefix:
First Name:ALICIA
Middle Name:M
Last Name:GARDNER
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:ALICIA
Other - Middle Name:M
Other - Last Name:ARGUELLES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:PO BOX 66663
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87193-6663
Mailing Address - Country:US
Mailing Address - Phone:505-620-2354
Mailing Address - Fax:
Practice Address - Street 1:1000 ROBERT RD
Practice Address - Street 2:
Practice Address - City:GRANTS
Practice Address - State:NM
Practice Address - Zip Code:87020-4012
Practice Address - Country:US
Practice Address - Phone:505-285-3378
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-04
Last Update Date:2014-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMRP00008002183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist