James Blythe
Individual provider Active NPI Pharmacist · Acoma, NM
NPI 1669937074 · NPPES record last updated Feb 11, 2019
Key facts
- NPI
- 1669937074
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pharmacist 183500000X
- License
- PD14629 (AR)
- Practice address
- 80 Veterens Blvd
Acoma, NM 87049 - Phone
- (505) 552-5813
- NPI assigned
- Feb 11, 2019
- 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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PD14629 | AR | MD | Pharmacist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | PD14629 | AR | Yes |
Addresses
Primary practice location
80 Veterens Blvd
Acoma, NM 87049
Mailing address
9206 Brigadoon CV
Austin, TX 78750-3484
Other providers in Acoma, NM
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 11, 2019. 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.