Healthcare Provider Details

I. General information

NPI: 1366503369
Provider Name (Legal Business Name): PEDRO SOLIS JR. PHARM.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/13/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 VASSAR DR NE I.H.S. ALBUQUERQUE INDIAN HEALTH CENTER
ALBUQUERQUE NM
87106-2725
US

IV. Provider business mailing address

801 VASSAR DR NE I.H.S. ALBUQUERQUE INDIAN HEALTH CENTER
ALBUQUERQUE NM
87106-2725
US

V. Phone/Fax

Practice location:
  • Phone: 505-248-4028
  • Fax: 505-248-7642
Mailing address:
  • Phone: 505-248-4028
  • Fax: 505-248-7642

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License NumberRP00005715
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: