Cecil Mack Aycock, PHARM. D.
Individual provider Active NPI Pharmacist · Gallup, NM
NPI 1275647992 · NPPES record last updated Jul 8, 2008
Key facts
- NPI
- 1275647992
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pharmacist 183500000X
- License
- 9502 (TN)
- Practice address
- 516 Nizhoni Blvd
Gallup Indian Medical Center - Pharmacy
Gallup, NM 87301-5748 - Phone
- (505) 722-1211
- Fax
- (505) 726-8621
- NPI assigned
- Aug 19, 2006
- Sex
- Male
- 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 |
|---|---|---|---|
| 9502 | TN | MD | Pharmacist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 9502 | TN | Yes |
Addresses
Primary practice location
516 Nizhoni Blvd
Gallup Indian Medical Center - Pharmacy
Gallup, NM 87301-5748
Mailing address
516 Nizhoni Blvd
Gallup, NM 87301-5748
Phone (505) 722-1211
Other providers in Gallup, NM
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2008. 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.