Provider Demographics
NPI:1417628694
Name:GUTIERREZ, VICTORIA E (DOCTOR OF PHARMACY)
Entity Type:Individual
Prefix:DR
First Name:VICTORIA
Middle Name:E
Last Name:GUTIERREZ
Suffix:
Gender:F
Credentials:DOCTOR OF PHARMACY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1443
Mailing Address - Street 2:
Mailing Address - City:SOCORRO
Mailing Address - State:NM
Mailing Address - Zip Code:87801-1443
Mailing Address - Country:US
Mailing Address - Phone:505-660-6919
Mailing Address - Fax:
Practice Address - Street 1:700 6TH ST N
Practice Address - Street 2:
Practice Address - City:SOCORRO
Practice Address - State:NM
Practice Address - Zip Code:87801-4242
Practice Address - Country:US
Practice Address - Phone:575-838-1426
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-27
Last Update Date:2021-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMRP00009566183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist