Provider Demographics
NPI:1821136573
Name:NORMAN, DENISE A (RPH)
Entity Type:Individual
Prefix:
First Name:DENISE
Middle Name:A
Last Name:NORMAN
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:516 E. NIZHONI BLVD
Mailing Address - Street 2:GALLUP INDIAN MEDICAL CENTER (GIMC)
Mailing Address - City:GALLUP
Mailing Address - State:NM
Mailing Address - Zip Code:87301
Mailing Address - Country:US
Mailing Address - Phone:505-722-1185
Mailing Address - Fax:505-726-8621
Practice Address - Street 1:516 E. NIZHONI BLVD
Practice Address - Street 2:GALLUP INDIAN MEDICAL CENTER (GIMC)
Practice Address - City:GALLUP
Practice Address - State:NM
Practice Address - Zip Code:87301
Practice Address - Country:US
Practice Address - Phone:505-722-1185
Practice Address - Fax:505-726-8621
Is Sole Proprietor?:No
Enumeration Date:2007-02-02
Last Update Date:2011-06-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
DCPHA3153183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist