Provider Demographics
NPI:1033751920
Name:WOMACK, JARED W (PHARM D, RPH)
Entity Type:Individual
Prefix:
First Name:JARED
Middle Name:W
Last Name:WOMACK
Suffix:
Gender:M
Credentials:PHARM D, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 SILVER AVE SW STE D
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87102-3593
Mailing Address - Country:US
Mailing Address - Phone:505-705-3540
Mailing Address - Fax:505-847-0617
Practice Address - Street 1:205 SILVER AVE SW STE D
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87102-3593
Practice Address - Country:US
Practice Address - Phone:505-705-3540
Practice Address - Fax:505-847-0617
Is Sole Proprietor?:No
Enumeration Date:2019-10-11
Last Update Date:2019-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMRP00009192183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist