Provider Demographics
NPI:1053510891
Name:LOVELACE PHARMACY
Entity type:Organization
Organization Name:LOVELACE PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:CLAIRE
Authorized Official - Middle Name:SUZANNE
Authorized Official - Last Name:SEELINGER
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:505-268-2109
Mailing Address - Street 1:4201 ROMA AVE NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87108-1133
Mailing Address - Country:US
Mailing Address - Phone:505-268-2109
Mailing Address - Fax:505-237-8701
Practice Address - Street 1:13701 ENCANTADO RD NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87123-2275
Practice Address - Country:US
Practice Address - Phone:505-237-8762
Practice Address - Fax:505-237-8701
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-12
Last Update Date:2007-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMRP00006057302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization