Provider Demographics
NPI:1114149499
Name:MEZA, JOSE L (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:JOSE
Middle Name:L
Last Name:MEZA
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1802 AVENIDA BONITA NW
Mailing Address - Street 2:
Mailing Address - City:LOS LUNAS
Mailing Address - State:NM
Mailing Address - Zip Code:87031-8370
Mailing Address - Country:US
Mailing Address - Phone:505-865-2089
Mailing Address - Fax:505-865-2829
Practice Address - Street 1:2351 MAIN ST SE
Practice Address - Street 2:
Practice Address - City:LOS LUNAS
Practice Address - State:NM
Practice Address - Zip Code:87031-8370
Practice Address - Country:US
Practice Address - Phone:505-865-2089
Practice Address - Fax:505-865-2829
Is Sole Proprietor?:No
Enumeration Date:2007-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMRP00006921183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist