Provider Demographics
NPI:1184712804
Name:SENA, KATHRYN JEWELINA (PHARMD, PHC, BCPS)
Entity type:Individual
Prefix:DR
First Name:KATHRYN
Middle Name:JEWELINA
Last Name:SENA
Suffix:
Gender:F
Credentials:PHARMD, PHC, BCPS
Other - Prefix:DR
Other - First Name:KATHRYN
Other - Middle Name:JEWELING
Other - Last Name:GRUCHALLA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD, PHC
Mailing Address - Street 1:1100 CENTRAL AVE SE
Mailing Address - Street 2:PHARMACY ADMINISTRATION
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87106-4930
Mailing Address - Country:US
Mailing Address - Phone:505-724-7761
Mailing Address - Fax:
Practice Address - Street 1:1100 CENTRAL AVE SE
Practice Address - Street 2:PHARMACY ADMINISTRATION
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87106-4930
Practice Address - Country:US
Practice Address - Phone:505-724-7761
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2012-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMRP00006914183500000X
NMPC000001611835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist