Provider Demographics
NPI:1497006621
Name:GUTIERREZ, ORLANDO ERNIE (RPH)
Entity Type:Individual
Prefix:
First Name:ORLANDO
Middle Name:ERNIE
Last Name:GUTIERREZ
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6105 WHITEMAN DR NW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87120-2194
Mailing Address - Country:US
Mailing Address - Phone:505-771-8411
Mailing Address - Fax:505-771-9255
Practice Address - Street 1:7800 ENCHANTED HILLS BLVD NE
Practice Address - Street 2:
Practice Address - City:RIO RANCHO
Practice Address - State:NM
Practice Address - Zip Code:87144-9997
Practice Address - Country:US
Practice Address - Phone:505-771-8411
Practice Address - Fax:505-771-9255
Is Sole Proprietor?:No
Enumeration Date:2012-09-27
Last Update Date:2012-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM6280183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist