Provider Demographics
NPI:1336453562
Name:AVALOS, IRMA (RPH)
Entity type:Individual
Prefix:MRS
First Name:IRMA
Middle Name:
Last Name:AVALOS
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:IRMA
Other - Middle Name:
Other - Last Name:ROBLES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1209 UNIVERSITY BLVD NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87102-1727
Mailing Address - Country:US
Mailing Address - Phone:505-272-4400
Mailing Address - Fax:
Practice Address - Street 1:1209 UNIVERSITY BLVD NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87102-1727
Practice Address - Country:US
Practice Address - Phone:505-220-7152
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-29
Last Update Date:2023-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMRPH00006368183500000X
NMPC000001981835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
No183500000XPharmacy Service ProvidersPharmacist