Active NPI
Jacqueline Phan
- Pharmacist
- Albuquerque, NM
National Provider Identifier
1699441279
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- RP00009545
- Practice address
- 8000 Academy Rd NE
Albuquerque, NM 87111-1159 - Phone
- (505) 821-6008
- NPI assigned
- Aug 23, 2021
- Last updated
- Aug 23, 2021
- Sex
- Female
- Sole proprietor
- Yes
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 | RP00009545 | NM | Primary |
Addresses
Primary practice location
8000 Academy Rd NE
Albuquerque, NM 87111-1159
Mailing address
12417 Rosemont Ave NE
Albuquerque, NM 87112-5723
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 |
|---|---|---|---|
| RP00009545 | NM | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1629676800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1629676800000",
"number": "1699441279",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "12417 ROSEMONT AVE NE",
"city": "ALBUQUERQUE",
"state": "NM",
"postal_code": "871125723"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "8000 ACADEMY RD NE",
"city": "ALBUQUERQUE",
"state": "NM",
"postal_code": "871111159",
"telephone_number": "505-821-6008"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PHAN",
"first_name": "JACQUELINE",
"name_prefix": "Dr.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2021-08-23",
"last_updated": "2021-08-23",
"certification_date": "2021-08-23",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "NM",
"license": "RP00009545",
"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 Aug 23, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.