Healthcare Provider Details

I. General information

NPI: 1891963922
Provider Name (Legal Business Name): ROBERT MARK NELSON SR. RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/12/2008
Last Update Date: 11/17/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8011 VENTURA ST NE
ALBUQUERQUE NM
87109-6429
US

IV. Provider business mailing address

5604 FAIR OAK TRL NE
ALBUQUERQUE NM
87109-3209
US

V. Phone/Fax

Practice location:
  • Phone: 505-217-2860
  • Fax: 505-217-2866
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP00004158
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: