Active NPI
Justin Kotobi
- Pharmacist
- Albuquerque, NM
National Provider Identifier
1710694013
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- RP00000106
- Practice address
- 8100 Wyoming Blvd NE
Albuquerque, NM 87113-1946 - Phone
- (505) 857-9783
- NPI assigned
- Nov 4, 2022
- Sex
- Male
- 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 | RP00000106 | NM | Primary |
Addresses
Primary practice location
8100 Wyoming Blvd NE
Albuquerque, NM 87113-1946
Mailing address
9215 Black Farm LN NW
Albuquerque, NM 87114-5957
Phone (505) 977-8962
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 |
|---|---|---|---|
| RP00000106 | NM | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1667520000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1667520000000",
"number": "1710694013",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9215 BLACK FARM LN NW",
"city": "ALBUQUERQUE",
"state": "NM",
"postal_code": "871145957",
"telephone_number": "505-977-8962"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "8100 WYOMING BLVD NE",
"city": "ALBUQUERQUE",
"state": "NM",
"postal_code": "871131946",
"telephone_number": "505-857-9783"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KOTOBI",
"first_name": "JUSTIN",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2022-11-04",
"last_updated": "2022-11-04",
"certification_date": "2022-11-04",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "NM",
"license": "RP00000106",
"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 Nov 4, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.