Healthcare Provider Details

I. General information

NPI: 1265074405
Provider Name (Legal Business Name): ANDREW JACOB REUTER PHARM D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/09/2019
Last Update Date: 10/09/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3816 COPPER AVE NE UNIT A
ALBUQUERQUE NM
87108
US

IV. Provider business mailing address

3816 COPPER AVE NE UNIT A
ALBUQUERQUE NM
87108
US

V. Phone/Fax

Practice location:
  • Phone: 973-896-8402
  • Fax:
Mailing address:
  • Phone: 973-896-8402
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number0021938
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: