Healthcare Provider Details

I. General information

NPI: 1669978946
Provider Name (Legal Business Name): JEREMY POCHATKO PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/04/2018
Last Update Date: 12/29/2025
Certification Date: 12/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1115 N RIVERSIDE DR
ESPANOLA NM
87532-2802
US

IV. Provider business mailing address

1115 N RIVERSIDE DR
ESPANOLA NM
87532-2802
US

V. Phone/Fax

Practice location:
  • Phone: 505-753-7005
  • Fax:
Mailing address:
  • Phone: 505-733-7005
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number43395
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP00010052
License Number StateNM
# 3
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number03136123
License Number StateOH
# 4
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP448970
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: