Provider Demographics
NPI:1144434259
Name:CAVALLARI, GLORIA M (RPH)
Entity type:Individual
Prefix:
First Name:GLORIA
Middle Name:M
Last Name:CAVALLARI
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 1:4801 IRVING BLVD NW
Mailing Address - Street 2:UNIT 2803
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87114-3820
Mailing Address - Country:US
Mailing Address - Phone:505-792-0234
Mailing Address - Fax:
Practice Address - Street 1:7101 WYOMING BLVD NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-4868
Practice Address - Country:US
Practice Address - Phone:505-821-1275
Practice Address - Fax:505-821-6832
Is Sole Proprietor?:No
Enumeration Date:2007-05-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMRP00006535183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist