Healthcare Provider Details

I. General information

NPI: 1689928079
Provider Name (Legal Business Name): JANA BONNETT PHARM D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/06/2012
Last Update Date: 11/06/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5150 JOURNAL CENTER BLVD NE
ALBUQUERQUE NM
87109-5900
US

IV. Provider business mailing address

3800 PINON JAY CT NW
ALBUQUERQUE NM
87120-4094
US

V. Phone/Fax

Practice location:
  • Phone: 505-727-5920
  • Fax:
Mailing address:
  • Phone: 505-280-9266
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP00007844
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: