Provider Demographics
NPI:1629526645
Name:HERRERA, ANNETTE S (PHARM D)
Entity Type:Individual
Prefix:
First Name:ANNETTE
Middle Name:S
Last Name:HERRERA
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:DR
Other - First Name:ANNETTE
Other - Middle Name:S
Other - Last Name:GIDDINGS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARM D
Mailing Address - Street 1:6125 4TH ST NW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87107-5755
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6125 4TH ST NW
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87107-5755
Practice Address - Country:US
Practice Address - Phone:505-344-3509
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-19
Last Update Date:2016-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMRP00006491183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist