Most Relevant Information
Provider Data
| NPI Number: | 1003000746 |
| Provider Name: | MIKE LEE GALLEGOS PHC |
| Entity Type: | Individual |
| Taxonomy Code: | 183500000X |
| Specialty: | Pharmacist |
| License Number: | 6838 |
Most Important Dates
| Enumeration Date: | 09/05/2007 |
| Last Updated: | 08/02/2021 |
Provider Practice Location
221 STATE HIGHWAY 165
A-4
PLACITAS
NM
87043
Practice Location Phone/Fax
| Phone: | 5058670733 |
| Fax: | 5057850886 |
Provider Mailing Location
221 STATE HIGHWAY 165
A-4
PLACITAS
NM
87043
Provider Mailing Phone/Fax
| Phone: | 5058670733 |
| Fax: | 5057850886 |