Provider Demographics
NPI:1104804616
Name:DAHLKE, MARIA KLEMENT (PHARMD, PC)
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:KLEMENT
Last Name:DAHLKE
Suffix:
Gender:F
Credentials:PHARMD, PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 N WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:NM
Mailing Address - Zip Code:88201-3066
Mailing Address - Country:US
Mailing Address - Phone:619-200-5205
Mailing Address - Fax:
Practice Address - Street 1:300 N WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:NM
Practice Address - Zip Code:88201-3066
Practice Address - Country:US
Practice Address - Phone:619-200-5205
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-04
Last Update Date:2011-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE101601835P1200X
NMPC000001871835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
No1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy