MEDICARE: DR. AERIN GRECO PHARMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	2003006463	MO
2	1835P0018X	Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist	RP006670	NM

General Provider Information

NPI Number	:	1265771539
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. AERIN GRECO PHARMD

Provider Business Mailing Address
First Line	:	9108 HAGERMAN AVE NE
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87109-6452
Country	:	US
Telephone Number	:	505-828-0056
Fax Number	:

Provider Business Practice Location Address
First Line	:	9108 HAGERMAN AVE NE
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87109-6452
Country	:	US
Telephone Number	:	505-828-0056
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/06/2013
Last Update Date	:	02/06/2013

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