Healthcare Provider Details

I. General information

NPI: 1255601522
Provider Name (Legal Business Name): JONATHAN L SZKOTAK PHARM.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/04/2012
Last Update Date: 11/19/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 UNIVERSITY BLVD SE, SUITE 208 MSC12 7120, 1 UNM
ALBUQUERQUE NM
87106
US

IV. Provider business mailing address

801 UNIVERSITY BLVD SE, SUITE 208 MSC12 7120, 1 UNM
ALBUQUERQUE NM
87106
US

V. Phone/Fax

Practice location:
  • Phone: 505-925-2432
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number66330
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: