Provider Demographics
NPI:1497001572
Name:GUERRERO, JACQUELINE (PHARM D)
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:
Last Name:GUERRERO
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:JACQUELINE
Other - Middle Name:
Other - Last Name:CARRILLO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARM D
Mailing Address - Street 1:5510 LOMAS BLVD NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87110-6545
Mailing Address - Country:US
Mailing Address - Phone:505-265-6868
Mailing Address - Fax:505-256-9196
Practice Address - Street 1:5510 LOMAS BLVD NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87110-6545
Practice Address - Country:US
Practice Address - Phone:505-265-6868
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-26
Last Update Date:2020-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMRP00007846183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist