Provider Demographics
NPI:1134850258
Name:MAGALLANES, ADAN (PHARMD)
Entity type:Individual
Prefix:
First Name:ADAN
Middle Name:
Last Name:MAGALLANES
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 1:933 SAN MATEO BLVD NE STE 501
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87108-1956
Mailing Address - Country:US
Mailing Address - Phone:505-313-8080
Mailing Address - Fax:
Practice Address - Street 1:933 SAN MATEO BLVD NE STE 501
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87108-1956
Practice Address - Country:US
Practice Address - Phone:505-313-8080
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-20
Last Update Date:2022-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMRP00009662183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist