Healthcare Provider Details

I. General information

NPI: 1255578696
Provider Name (Legal Business Name): AMADO LEROY ROMERO JR. RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/07/2009
Last Update Date: 01/07/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 CENTRAL AVE SE 3 RUTH HANNA BLDG
ALBUQUERQUE NM
87106-4930
US

IV. Provider business mailing address

1100 CENTRAL AVE SE 3 RUTH HANNA BLDG
ALBUQUERQUE NM
87106-4930
US

V. Phone/Fax

Practice location:
  • Phone: 505-724-8927
  • Fax: 505-724-6024
Mailing address:
  • Phone: 505-724-8927
  • Fax: 505-724-6024

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP00005329
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: