Provider Demographics
NPI:1346665536
Name:GABALDON, DENISE (PHARMD)
Entity Type:Individual
Prefix:
First Name:DENISE
Middle Name:
Last Name:GABALDON
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 1:2250 MAIN ST NW
Mailing Address - Street 2:
Mailing Address - City:LOS LUNAS
Mailing Address - State:NM
Mailing Address - Zip Code:87031-4807
Mailing Address - Country:US
Mailing Address - Phone:505-565-4622
Mailing Address - Fax:505-565-4625
Practice Address - Street 1:2250 MAIN ST NW
Practice Address - Street 2:
Practice Address - City:LOS LUNAS
Practice Address - State:NM
Practice Address - Zip Code:87031-4807
Practice Address - Country:US
Practice Address - Phone:505-565-4622
Practice Address - Fax:505-565-4625
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-24
Last Update Date:2014-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM6506183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist