Provider Demographics
NPI:1538576830
Name:MICHAEL, BARBARA LYNN (RPH)
Entity type:Individual
Prefix:MS
First Name:BARBARA
Middle Name:LYNN
Last Name:MICHAEL
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:MS
Other - First Name:BARBARA
Other - Middle Name:LYNN
Other - Last Name:BALDONADO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2500 MAIN ST NE
Mailing Address - Street 2:
Mailing Address - City:LOS LUNAS
Mailing Address - State:NM
Mailing Address - Zip Code:87031-6340
Mailing Address - Country:US
Mailing Address - Phone:505-565-4622
Mailing Address - Fax:505-565-4625
Practice Address - Street 1:2500 MAIN ST NE
Practice Address - Street 2:
Practice Address - City:LOS LUNAS
Practice Address - State:NM
Practice Address - Zip Code:87031-6340
Practice Address - Country:US
Practice Address - Phone:505-565-4622
Practice Address - Fax:505-565-4625
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-18
Last Update Date:2014-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM5144183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist