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NPI Code Detail

MEDICARE: VITALIYA PETKO

MEDICARE: VITALIYA PETKO
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
1183500000XPharmacistRP00007537NM

General Provider Information

NPI Number : 1831506963
Entity Type Code : Individual
Provider Name (Legal Business Name) : VITALIYA PETKO
Provider Business Mailing Address
First Line : 5119 GLENWOOD POINTE LN NE
Second Line :
City : ALBUQUERQUE
State : NM
Zip : 87111-2976
Country : US
Telephone Number : 505-216-1731
Fax Number :
Provider Business Practice Location Address
First Line : 2266 WYOMING BLVD NE
Second Line :
City : ALBUQUERQUE
State : NM
Zip : 87112-2620
Country : US
Telephone Number : 595-323-2885
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/21/2014
Last Update Date : 07/21/2014

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Directions to “ VITALIYA PETKO ” Practice Location

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