Healthcare Provider Details

I. General information

NPI: 1891101143
Provider Name (Legal Business Name): RAJESWARA CHARY PINNOJI
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/08/2014
Last Update Date: 07/08/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1021 E PINE ST WALMART
DEMING NM
88030-7009
US

IV. Provider business mailing address

3245 E UNIVERSITY AVE APT 1012
LAS CRUCES NM
88011-9137
US

V. Phone/Fax

Practice location:
  • Phone: 575-546-6746
  • Fax: 575-546-6748
Mailing address:
  • Phone: 318-344-1512
  • Fax: 575-546-6748

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP00007729
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: