Healthcare Provider Details

I. General information

NPI: 1497001572
Provider Name (Legal Business Name): JACQUELINE GUERRERO PHARM. D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JACQUELINE CARRILLO PHARM. D

II. Dates (important events)

Enumeration Date: 07/26/2012
Last Update Date: 01/28/2020
Certification Date: 01/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5510 LOMAS BLVD NE
ALBUQUERQUE NM
87110-6545
US

IV. Provider business mailing address

5510 LOMAS BLVD NE
ALBUQUERQUE NM
87110-6545
US

V. Phone/Fax

Practice location:
  • Phone: 505-265-6868
  • Fax:
Mailing address:
  • Phone: 505-265-6868
  • Fax: 505-256-9196

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP00007846
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: