Healthcare Provider Details

I. General information

NPI: 1780935544
Provider Name (Legal Business Name): SAM SANCHEZ JR. PHARMACIST
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/19/2012
Last Update Date: 09/19/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 WALTER ST NE
ALBUQUERQUE NM
87102-2534
US

IV. Provider business mailing address

6715 SEVILLE PL NW
ALBUQUERQUE NM
87120-3034
US

V. Phone/Fax

Practice location:
  • Phone: 505-727-2900
  • Fax:
Mailing address:
  • Phone: 505-727-2900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number5680
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: