Provider Demographics
NPI:1396146676
Name:SEGURA, HEIDI (PHARMD)
Entity type:Individual
Prefix:
First Name:HEIDI
Middle Name:
Last Name:SEGURA
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9600 SAGE RD SW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87121-6803
Mailing Address - Country:US
Mailing Address - Phone:505-831-4023
Mailing Address - Fax:505-831-4030
Practice Address - Street 1:9600 SAGE RD SW
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87121-6803
Practice Address - Country:US
Practice Address - Phone:505-831-4023
Practice Address - Fax:505-831-4030
Is Sole Proprietor?:No
Enumeration Date:2014-09-05
Last Update Date:2014-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMRP00007594183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist