Healthcare Provider Details

I. General information

NPI: 1619201522
Provider Name (Legal Business Name): JON TERRIBILINI PHARM D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/24/2009
Last Update Date: 09/24/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6000 COORS BLVD NW # D
ALBUQUERQUE NM
87120-2702
US

IV. Provider business mailing address

6000 COORS BLVD NW # D
ALBUQUERQUE NM
87120-2702
US

V. Phone/Fax

Practice location:
  • Phone: 505-899-0989
  • Fax: 505-899-2741
Mailing address:
  • Phone: 505-899-0989
  • Fax: 505-899-2741

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP00007302
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: