Active NPI
Shauntiana Enrico
- Pharmacist
- Albuquerque, NM
National Provider Identifier
1255040523
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- RP00009804
- Practice address
- 801 Vassar Dr NE
Albuquerque, NM 87106-2725 - Phone
- (505) 248-7730
- NPI assigned
- Nov 15, 2022
- Sex
- Female
- 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 | RP00009804 | NM | Primary |
Addresses
Primary practice location
801 Vassar Dr NE
Albuquerque, NM 87106-2725
Mailing address
PO Box 1608
Crownpoint, NM 87313-1608
Phone (505) 422-1248
Other practice location 1
980 US Highway 491
Gallup, NM 87301-5339
Phone (505) 722-9977
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| RP00009804 | NM | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Safeway Inc | Past | Accepting new patients | |
| Safeway Inc | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1668470400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1677110400000",
"number": "1255040523",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 1608",
"city": "CROWNPOINT",
"state": "NM",
"postal_code": "873131608",
"telephone_number": "505-422-1248"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "801 VASSAR DR NE",
"city": "ALBUQUERQUE",
"state": "NM",
"postal_code": "871062725",
"telephone_number": "505-248-7730"
}
],
"practiceLocations": [
{
"address_1": "980 US Highway 491",
"address_purpose": "LOCATION",
"city": "Gallup",
"state": "NM",
"postal_code": "873015339",
"country_code": "US",
"telephone_number": "505-722-9977",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "ENRICO",
"first_name": "SHAUNTIANA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2022-11-15",
"last_updated": "2023-02-23",
"certification_date": "2023-02-23",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "NM",
"license": "RP00009804",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Albuquerque, NM
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 23, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.