MEDICARE: JOSEFITA MAGDELENA SANTANA RPH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1835P1200X	Pharmacotherapy Pharmacist	005032	NM

General Provider Information

NPI Number	:	1093302838
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOSEFITA MAGDELENA SANTANA RPH

Provider Business Mailing Address
First Line	:	PO BOX 23674
Second Line	:
City	:	SANTA FE
State	:	NM
Zip	:	87502-3674
Country	:	US
Telephone Number	:	505-980-6530
Fax Number	:

Provider Business Practice Location Address
First Line	:	2907 CERRILLOS RD
Second Line	:
City	:	SANTA FE
State	:	NM
Zip	:	87507-2310
Country	:	US
Telephone Number	:	505-471-4660
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/28/2020
Last Update Date	:	12/28/2020

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