Healthcare Provider Details

I. General information

NPI: 1730392101
Provider Name (Legal Business Name): JACK FIELDS SONA II RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/08/2007
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

JACK SONA, RPH 100 LLANO ST
AZTEC NM
87410
US

IV. Provider business mailing address

100 LLANO ST
AZTEC NM
87410
US

V. Phone/Fax

Practice location:
  • Phone: 505-334-6411
  • Fax: 505-334-7187
Mailing address:
  • Phone: 505-327-7744
  • Fax: 505-334-7187

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number3499
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: