Provider Demographics
NPI:1326192063
Name:SARNOWSKI, MARK EDWARD (RPH, CCN)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:EDWARD
Last Name:SARNOWSKI
Suffix:
Gender:M
Credentials:RPH, CCN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2225 CALLE ALVARADO
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87505-4942
Mailing Address - Country:US
Mailing Address - Phone:505-982-6374
Mailing Address - Fax:505-473-0842
Practice Address - Street 1:2225 CALLE ALVARADO
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-4942
Practice Address - Country:US
Practice Address - Phone:505-982-6374
Practice Address - Fax:505-473-0842
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMNM48891835N1003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835N1003XPharmacy Service ProvidersPharmacistNutrition Support