Provider Demographics
NPI:1558581009
Name:BRODERICK, PAULA RENEE (PHARMD)
Entity type:Individual
Prefix:
First Name:PAULA
Middle Name:RENEE
Last Name:BRODERICK
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6212 KEYENTA PL NW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87120-3281
Mailing Address - Country:US
Mailing Address - Phone:505-321-3971
Mailing Address - Fax:
Practice Address - Street 1:10052 COORS BLVD NW
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87114-4020
Practice Address - Country:US
Practice Address - Phone:505-459-0025
Practice Address - Fax:505-899-8372
Is Sole Proprietor?:No
Enumeration Date:2007-04-26
Last Update Date:2025-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM55311835P1200X
171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy