Provider Demographics
NPI:1164531950
Name:TRUJILLO, JONATHAN NEIL (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:NEIL
Last Name:TRUJILLO
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 1:9999 RADCLIFFE RD NW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87114-4410
Mailing Address - Country:US
Mailing Address - Phone:505-717-5354
Mailing Address - Fax:
Practice Address - Street 1:85 WEST HIGHWAY 22
Practice Address - Street 2:SANTO DOMINGO HEALTH CENTER
Practice Address - City:SANTO DOMINGO
Practice Address - State:NM
Practice Address - Zip Code:87052
Practice Address - Country:US
Practice Address - Phone:505-465-3073
Practice Address - Fax:505-465-1168
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2015-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMPC000001511835P0018X
NMRP000066151835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy
No1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist