Provider Demographics
NPI:1194935502
Name:ENRIQUEZ, HENRIETTA (RPH)
Entity type:Individual
Prefix:
First Name:HENRIETTA
Middle Name:
Last Name:ENRIQUEZ
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 1:18424 S HWY 28
Mailing Address - Street 2:PO DRAWER D
Mailing Address - City:SAN MIGUEL
Mailing Address - State:NM
Mailing Address - Zip Code:88058
Mailing Address - Country:US
Mailing Address - Phone:505-233-4270
Mailing Address - Fax:505-524-4266
Practice Address - Street 1:18424 S. HWY 28
Practice Address - Street 2:
Practice Address - City:SAN MIGUEL
Practice Address - State:NM
Practice Address - Zip Code:88058
Practice Address - Country:US
Practice Address - Phone:505-526-1105
Practice Address - Fax:505-524-4266
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMRP00006158183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist