Healthcare Provider Details

I. General information

NPI: 1255690137
Provider Name (Legal Business Name): THOMAS COONEY RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2012
Last Update Date: 05/11/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10131 COORS BLVD NW
ALBUQUERQUE NM
87114-4045
US

IV. Provider business mailing address

10444 CALLE LEON NW
ALBUQUERQUE NM
87114-1807
US

V. Phone/Fax

Practice location:
  • Phone: 505-897-3884
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP00007104
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: