Provider Demographics
NPI:1386977676
Name:CHAVEZ, BETH ANN (RPH)
Entity type:Individual
Prefix:
First Name:BETH
Middle Name:ANN
Last Name:CHAVEZ
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 1:1425 SAN CARLOS RD SW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87104-1040
Mailing Address - Country:US
Mailing Address - Phone:505-843-6334
Mailing Address - Fax:
Practice Address - Street 1:3400 COORS BLVD NW
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87120-1448
Practice Address - Country:US
Practice Address - Phone:505-836-4111
Practice Address - Fax:505-836-9629
Is Sole Proprietor?:No
Enumeration Date:2009-09-17
Last Update Date:2009-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM5319183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist