Healthcare Provider Details

I. General information

NPI: 1407226178
Provider Name (Legal Business Name): WILLIAM SURROCK PHARM.D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/06/2015
Last Update Date: 10/06/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10800 UNSER BLVD NW
ALBUQUERQUE NM
87114-1064
US

IV. Provider business mailing address

2522 CONTRERAS RD NE
RIO RANCHO NM
87144-5627
US

V. Phone/Fax

Practice location:
  • Phone: 505-205-1849
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP00008454
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: