MEDICARE: ORLANDO ERNIE GUTIERREZ 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	183500000X	Pharmacist	6280	NM

General Provider Information

NPI Number	:	1497006621
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ORLANDO ERNIE GUTIERREZ RPH

Provider Business Mailing Address
First Line	:	6105 WHITEMAN DR NW
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87120-2194
Country	:	US
Telephone Number	:	505-771-8411
Fax Number	:	505-771-9255

Provider Business Practice Location Address
First Line	:	7800 ENCHANTED HILLS BLVD NE
Second Line	:
City	:	RIO RANCHO
State	:	NM
Zip	:	87144-9997
Country	:	US
Telephone Number	:	505-771-8411
Fax Number	:	505-771-9255

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

Provider Enumeration Date	:	09/27/2012
Last Update Date	:	09/27/2012

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