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General NPI Number Information
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NPI Number | 1740607738
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Entity Type | Individual
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Provider Name | JAY SIMON RPH
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Gender | Male
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Dates
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Enumeration Date | 03/27/2014
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Last Update Date | 03/27/2014
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Provider Practice Location Address
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Address Line | 2502 MARBLE NE RM B-48
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City | ALBUQUERQUE
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State | NM
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Zip | 87131-0001
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Country | US
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Telephone | 505-925-0748
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Fax |
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Provider Business Mailing Address
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Address Line | 53 ROCK RIDGE CT NE
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City | ALBUQUERQUE
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State | NM
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Zip | 87122-2023
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Country | US
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Telephone | 505-306-6742
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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 | 1835N0905X
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Taxonomy Name | Nuclear Pharmacist
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License Number | RP00008035
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License Number State | NM
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