Provider Demographics
NPI:1245237759
Name:MONSKE, MICHAEL L (PHARMD, PHC)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:L
Last Name:MONSKE
Suffix:
Gender:M
Credentials:PHARMD, PHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9132 VILLAGE AVE NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87122-2606
Mailing Address - Country:US
Mailing Address - Phone:505-831-7319
Mailing Address - Fax:
Practice Address - Street 1:530 W CORDOVA RD
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-1844
Practice Address - Country:US
Practice Address - Phone:505-820-1517
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMPC00000115183500000X
NMRP00006678183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist