Provider Demographics
NPI:1336278464
Name:DE SANTIS, NUNZIO PAUL (BSPHARM)
Entity Type:Individual
Prefix:MR
First Name:NUNZIO
Middle Name:PAUL
Last Name:DE SANTIS
Suffix:
Gender:M
Credentials:BSPHARM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:301 LAGUNA BLVD SW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87104-1112
Mailing Address - Country:US
Mailing Address - Phone:505-345-1403
Mailing Address - Fax:505-345-0199
Practice Address - Street 1:301 LAGUNA BLVD SW
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87104-1112
Practice Address - Country:US
Practice Address - Phone:505-345-1403
Practice Address - Fax:505-345-0199
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMRP00006357183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist