Provider Demographics
NPI:1679714836
Name:HAIRGROVE, DEBORAH KAREN (RPH)
Entity type:Individual
Prefix:
First Name:DEBORAH
Middle Name:KAREN
Last Name:HAIRGROVE
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 1:3213 SUE CIR SE
Mailing Address - Street 2:
Mailing Address - City:RIO RANCHO
Mailing Address - State:NM
Mailing Address - Zip Code:87124-2047
Mailing Address - Country:US
Mailing Address - Phone:505-994-8324
Mailing Address - Fax:
Practice Address - Street 1:100 E HWY 550
Practice Address - Street 2:
Practice Address - City:BERNALILLO
Practice Address - State:NM
Practice Address - Zip Code:87004-5967
Practice Address - Country:US
Practice Address - Phone:505-867-6071
Practice Address - Fax:505-867-3530
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-18
Last Update Date:2009-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMRP00006328183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist