Healthcare Provider Details

I. General information

NPI: 1033554985
Provider Name (Legal Business Name): RONALD G KITTSON PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/06/2013
Last Update Date: 05/06/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 CAMINO DE SALUD NE SUITE 4400
ALBUQUERQUE NM
87102-4517
US

IV. Provider business mailing address

1201 CAMINO DE SALUD NE SUITE 4400
ALBUQUERQUE NM
87102-4517
US

V. Phone/Fax

Practice location:
  • Phone: 505-925-0123
  • Fax: 505-925-0122
Mailing address:
  • Phone: 505-925-0123
  • Fax: 505-925-0122

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835X0200X
TaxonomyOncology Pharmacist
License NumberRP00007742
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: