Provider Demographics
NPI:1427381003
Name:RESTA, JUANITA M (RPH)
Entity Type:Individual
Prefix:MRS
First Name:JUANITA
Middle Name:M
Last Name:RESTA
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1941 SOUTHERN BLVD SE
Mailing Address - Street 2:
Mailing Address - City:RIO RANCHO
Mailing Address - State:NM
Mailing Address - Zip Code:87124-3510
Mailing Address - Country:US
Mailing Address - Phone:505-891-8186
Mailing Address - Fax:505-892-8017
Practice Address - Street 1:1941 SOUTHERN BLVD SE
Practice Address - Street 2:
Practice Address - City:RIO RANCHO
Practice Address - State:NM
Practice Address - Zip Code:87124-3510
Practice Address - Country:US
Practice Address - Phone:505-891-8186
Practice Address - Fax:505-892-8017
Is Sole Proprietor?:No
Enumeration Date:2009-09-14
Last Update Date:2009-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM6118183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist