MEDICARE: AMY NIETO PHARMD

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	RP00006996	NM

General Provider Information

NPI Number	:	1942616362
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMY NIETO PHARMD

Provider Business Mailing Address
First Line	:	2550 COORS BLVD NW
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87120-2123
Country	:	US
Telephone Number	:	505-352-1880
Fax Number	:	505-352-5727

Provider Business Practice Location Address
First Line	:	2550 COORS BLVD NW
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87120-2123
Country	:	US
Telephone Number	:	505-352-1880
Fax Number	:	505-352-5727

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

Provider Enumeration Date	:	07/07/2014
Last Update Date	:	07/07/2014

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Directions to “ AMY NIETO PHARMD” Practice Location

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