Shoghi Arrey Agbortoko, PHARMD
Individual provider Active NPI Pharmacist · Gallup, NM
NPI 1417621103 · NPPES record last updated Aug 5, 2021
Key facts
- NPI
- 1417621103
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pharmacist 183500000X
- License
- P9399 (ID)
- Practice address
- 516 E Nizhoni Blvd
Gallup, NM 87301-5748 - Phone
- (505) 722-1000
- NPI assigned
- Aug 5, 2021
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|
| P9399 | ID | MD | Pharmacist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | P9399 | ID | Yes |
Addresses
Primary practice location
516 E Nizhoni Blvd
Gallup, NM 87301-5748
Mailing address
516 E Nizhoni Blvd
Gallup, NM 87301-5748
Phone (505) 722-1000
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 Aug 5, 2021. 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.