Provider Demographics
NPI:1376850107
Name:GARCIA, MICHAEL GARY (RPH)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:GARY
Last Name:GARCIA
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4705 FRIENDLY PL NW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87120-4499
Mailing Address - Country:US
Mailing Address - Phone:505-249-3941
Mailing Address - Fax:
Practice Address - Street 1:8301 GOLF COURSE RD NW
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87120-5801
Practice Address - Country:US
Practice Address - Phone:505-897-1321
Practice Address - Fax:505-897-1013
Is Sole Proprietor?:No
Enumeration Date:2010-08-31
Last Update Date:2010-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMRP00004768183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist