Healthcare Provider Details

I. General information

NPI: 1700752920
Provider Name (Legal Business Name): JEREMY MATTHEW SOTO PHARMD, RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/14/2025
Last Update Date: 10/24/2025
Certification Date: 10/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 COORS BLVD NW
ALBUQUERQUE NM
87121-2016
US

IV. Provider business mailing address

1008 NASHVILLE AVE SW
ALBUQUERQUE NM
87105-3784
US

V. Phone/Fax

Practice location:
  • Phone: 505-831-3147
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP00010401
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: