Provider Demographics
NPI:1457579401
Name:ALVAREZ, KATHY (RPH)
Entity type:Individual
Prefix:MRS
First Name:KATHY
Middle Name:
Last Name:ALVAREZ
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 1:109A FIN DEL SENDERO
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87506
Mailing Address - Country:US
Mailing Address - Phone:505-471-0725
Mailing Address - Fax:
Practice Address - Street 1:31 SHERWOOD BLVD
Practice Address - Street 2:
Practice Address - City:LOS ALAMOS
Practice Address - State:NM
Practice Address - Zip Code:87544-3730
Practice Address - Country:US
Practice Address - Phone:505-672-9457
Practice Address - Fax:505-672-1519
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMRP-6151183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMRP-6151OtherNMBOP LICENSE #