Provider Demographics
NPI:1184020679
Name:GUTIERREZ-OLIVAS, EDWINA ELIZABETH (PHARMD)
Entity Type:Individual
Prefix:
First Name:EDWINA
Middle Name:ELIZABETH
Last Name:GUTIERREZ-OLIVAS
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2580 MAIN ST NE
Mailing Address - Street 2:
Mailing Address - City:LOS LUNAS
Mailing Address - State:NM
Mailing Address - Zip Code:87031-6340
Mailing Address - Country:US
Mailing Address - Phone:505-865-3310
Mailing Address - Fax:505-866-1721
Practice Address - Street 1:2580 MAIN ST NE
Practice Address - Street 2:
Practice Address - City:LOS LUNAS
Practice Address - State:NM
Practice Address - Zip Code:87031-6340
Practice Address - Country:US
Practice Address - Phone:505-865-3310
Practice Address - Fax:505-866-1721
Is Sole Proprietor?:No
Enumeration Date:2014-11-10
Last Update Date:2014-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMRP00008264183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist