Provider Demographics
NPI:1659388007
Name:EYRING, MICHAEL CHANTZ (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:CHANTZ
Last Name:EYRING
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4900 KINGSWAY DR
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:NM
Mailing Address - Zip Code:87402-4861
Mailing Address - Country:US
Mailing Address - Phone:505-325-1299
Mailing Address - Fax:
Practice Address - Street 1:701 E 20TH ST
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:NM
Practice Address - Zip Code:87401-4204
Practice Address - Country:US
Practice Address - Phone:505-326-3342
Practice Address - Fax:505-325-4694
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMRP00006206183500000X
NMPC-00000101174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No174400000XOther Service ProvidersSpecialist