Healthcare Provider Details

I. General information

NPI: 1578870309
Provider Name (Legal Business Name): RUBEN D VIGIL R.PH, B.C.N.P.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2010
Last Update Date: 08/31/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

606 ARMENTA ST
SANTA FE NM
87505-0319
US

IV. Provider business mailing address

606 ARMENTA ST
SANTA FE NM
87505-0319
US

V. Phone/Fax

Practice location:
  • Phone: 505-820-5626
  • Fax: 505-989-6452
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number5859
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code1835N0905X
TaxonomyNuclear Pharmacist
License Number5859
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: