Provider Demographics
NPI:1578049532
Name:PEARCE, LINDSEY GRACE (PHARMD, RPH)
Entity Type:Individual
Prefix:
First Name:LINDSEY
Middle Name:GRACE
Last Name:PEARCE
Suffix:
Gender:F
Credentials:PHARMD, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 N UNION AVE
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:NM
Mailing Address - Zip Code:88201-3956
Mailing Address - Country:US
Mailing Address - Phone:575-622-6571
Mailing Address - Fax:575-623-3801
Practice Address - Street 1:700 N UNION AVE
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:NM
Practice Address - Zip Code:88201-3956
Practice Address - Country:US
Practice Address - Phone:575-622-6571
Practice Address - Fax:575-623-3801
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-12
Last Update Date:2018-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMRP00008914183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMRP00008914OtherNEW MEXICO BOARD OF PHARMACY