Jennifer L Bongartz, PHARMD
Individual provider Active NPI Pharmacotherapy Pharmacist · Shiprock, NM
NPI 1104195874 · NPPES record last updated Aug 23, 2013
Key facts
- NPI
- 1104195874
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pharmacotherapy Pharmacist 1835P1200X
- License
- RP00007685 (NM)
- Practice address
- US Hwy 491 North
Shiprock, NM 87420-0160 - Phone
- (505) 368-6001
- NPI assigned
- Dec 23, 2011
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Doctor of Pharmacy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| RP00007685 | NM | MD | Pharmacotherapy Pharmacist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacotherapy Pharmacist | 1835P1200X | RP00007685 | NM | Yes |
Addresses
Primary practice location
US Hwy 491 North
Shiprock, NM 87420-0160
Mailing address
PO Box 160
Shiprock, NM 87420-0160
Phone (505) 368-6001
Other providers in Shiprock, NM
- Leslee L. Blevins
- Laura N Bluemle
- Roseline Boateng
- Laura Bodnar
- Floyd P Bond
- Daniel Bordatto
- Krupa Patel Bordatto
- Michelle Rae Brandser
- Patricia A Breeden
- Marie Brown-Wagner
All providers in Shiprock, NM · Pharmacotherapy Pharmacist in New Mexico
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 23, 2013. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.