Provider Demographics
NPI:1477881811
Name:JURADO, ANNETTA SOPHIA (RPH)
Entity Type:Individual
Prefix:
First Name:ANNETTA
Middle Name:SOPHIA
Last Name:JURADO
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 1:448 E CALLE ESCORA
Mailing Address - Street 2:
Mailing Address - City:SAHUARITA
Mailing Address - State:AZ
Mailing Address - Zip Code:85629-5601
Mailing Address - Country:US
Mailing Address - Phone:575-621-1142
Mailing Address - Fax:
Practice Address - Street 1:1959 N GRAND AVE
Practice Address - Street 2:
Practice Address - City:NOGALES
Practice Address - State:AZ
Practice Address - Zip Code:85621-1341
Practice Address - Country:US
Practice Address - Phone:575-621-1142
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-11-23
Last Update Date:2009-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS016646183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist