Healthcare Provider Details

I. General information

NPI: 1356304851
Provider Name (Legal Business Name): MARYJO ZUNIC PHARM.D., BCPS, PHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARYJO BOOT

II. Dates (important events)

Enumeration Date: 04/07/2006
Last Update Date: 08/15/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 VASSAR DR NE
ALBUQUERQUE NM
87106-2725
US

IV. Provider business mailing address

7248 LA JARA CT NE
ALBUQUERQUE NM
87109
US

V. Phone/Fax

Practice location:
  • Phone: 505-248-7741
  • Fax: 505-248-7642
Mailing address:
  • Phone: 505-948-1747
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License NumberPC00000145
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: