Healthcare Provider Details

I. General information

NPI: 1962783761
Provider Name (Legal Business Name): JASON JARAMILLO PHARM D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/07/2011
Last Update Date: 09/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1870 E HWY 66
GALLUP NM
87301-6135
US

IV. Provider business mailing address

307 E LOGAN
GALLUP NM
87301
US

V. Phone/Fax

Practice location:
  • Phone: 505-722-9499
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP00007580
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: