Provider Demographics
NPI:1114116621
Name:LOVATO, JEANETTE DANIELLE (PHARM D)
Entity Type:Individual
Prefix:
First Name:JEANETTE
Middle Name:DANIELLE
Last Name:LOVATO
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:JEANETTE
Other - Middle Name:DANIELLE
Other - Last Name:LOVATO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:2913 DONA TERESA PL SW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87121-7460
Mailing Address - Country:US
Mailing Address - Phone:505-839-9160
Mailing Address - Fax:
Practice Address - Street 1:2121 JUAN TABO BLVD NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87112-3307
Practice Address - Country:US
Practice Address - Phone:505-237-8850
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-20
Last Update Date:2007-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMRP00007035183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist