Healthcare Provider Details

I. General information

NPI: 1457184319
Provider Name (Legal Business Name): RONNIE JAMES GRIEGO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2024
Last Update Date: 05/11/2026
Certification Date: 05/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

751 TRINITY DR
LOS ALAMOS NM
87544-3356
US

IV. Provider business mailing address

751 TRINITY DR
LOS ALAMOS NM
87544-3356
US

V. Phone/Fax

Practice location:
  • Phone: 505-661-2770
  • Fax:
Mailing address:
  • Phone: 505-661-2770
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License NumberRP00010192
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP00010192
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: