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General NPI Number Information
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NPI Number | 1700160785
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Entity Type | Individual
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Provider Name | RICHARD MENGONI R.PH.
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Gender | Male
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Dates
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Enumeration Date | 10/07/2011
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Last Update Date | 03/27/2013
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Provider Practice Location Address
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Address Line | 8011 VENTURA ST NE
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City | ALBUQUERQUE
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State | NM
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Zip | 87109-6429
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Country | US
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Telephone | 505-217-2860
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Fax | 505-217-2866
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Provider Business Mailing Address
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Address Line | 6620 HIGH RIDGE PL NE
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City | ALBUQUERQUE
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State | NM
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Zip | 87111-8174
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Country | US
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Telephone | 913-634-8435
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 12569
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License Number State | KS
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Taxonomy #2
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 4360
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License Number State | NM
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Taxonomy #3
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 044650
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License Number State | MO
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