Provider Demographics
NPI:1669010146
Name:LOVATO, LARRY (PHARM D RPH PHC)
Entity type:Individual
Prefix:
First Name:LARRY
Middle Name:
Last Name:LOVATO
Suffix:
Gender:M
Credentials:PHARM D RPH PHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1217 1ST ST NW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87102-1529
Mailing Address - Country:US
Mailing Address - Phone:505-767-1130
Mailing Address - Fax:505-766-6945
Practice Address - Street 1:1217 1ST ST NW
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87102-1529
Practice Address - Country:US
Practice Address - Phone:505-767-1130
Practice Address - Fax:505-766-6945
Is Sole Proprietor?:No
Enumeration Date:2019-12-16
Last Update Date:2020-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM000000071835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist