Provider Demographics
NPI:1235462425
Name:GRIEGO, PATRICK A
Entity Type:Individual
Prefix:MR
First Name:PATRICK
Middle Name:A
Last Name:GRIEGO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2625 SAN PEDRO DR NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87110-3320
Mailing Address - Country:US
Mailing Address - Phone:505-883-5760
Mailing Address - Fax:
Practice Address - Street 1:2625 SAN PEDRO DR NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87110-3320
Practice Address - Country:US
Practice Address - Phone:505-883-5760
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-09-07
Last Update Date:2009-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM3654183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist