Provider Demographics
NPI:1558764852
Name:GORWODA, ALEXA (PHARMD)
Entity Type:Individual
Prefix:
First Name:ALEXA
Middle Name:
Last Name:GORWODA
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 1:6629 ELWOOD DR NW
Mailing Address - Street 2:
Mailing Address - City:LOS RANCHOS
Mailing Address - State:NM
Mailing Address - Zip Code:87107-6106
Mailing Address - Country:US
Mailing Address - Phone:505-344-0838
Mailing Address - Fax:
Practice Address - Street 1:6629 ELWOOD DR NW
Practice Address - Street 2:
Practice Address - City:LOS RANCHOS
Practice Address - State:NM
Practice Address - Zip Code:87107-6106
Practice Address - Country:US
Practice Address - Phone:505-344-0838
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-30
Last Update Date:2014-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMRP00008209183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist