Active NPI
Jordan Ezeanyim, PHARMD
- Pharmacist
- Santa Fe, NM
National Provider Identifier
1205350170
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- RP00008752
- Practice address
- 1096 S Saint Francis Dr
Santa Fe, NM 87505-1654 - Phone
- (505) 982-9811
- NPI assigned
- Aug 1, 2017
- Last updated
- Aug 1, 2017
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | RP00008752 | NM | Primary |
Addresses
Primary practice location
1096 S Saint Francis Dr
Santa Fe, NM 87505-1654
Mailing address
2822 Arce LN SE
Rio Rancho, NM 87124-3290
Phone (505) 310-0776
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Pharmacy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| RP00008752 | NM | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1501545600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1501545600000",
"number": "1205350170",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2822 ARCE LN SE",
"city": "RIO RANCHO",
"state": "NM",
"postal_code": "871243290",
"telephone_number": "505-310-0776"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1096 S SAINT FRANCIS DR",
"city": "SANTA FE",
"state": "NM",
"postal_code": "875051654",
"telephone_number": "505-982-9811"
}
],
"practiceLocations": [],
"basic": {
"last_name": "EZEANYIM",
"first_name": "JORDAN",
"credential": "PHARMD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2017-08-01",
"last_updated": "2017-08-01",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "NM",
"license": "RP00008752",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Santa Fe, NM
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 1, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.