Provider Demographics
NPI:1508147026
Name:GONZALEZ-REED, JAMIE HOKUOKALANI (RPH)
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:HOKUOKALANI
Last Name:GONZALEZ-REED
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 1:9955 COORS BYPASS NW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87114-6196
Mailing Address - Country:US
Mailing Address - Phone:505-922-7409
Mailing Address - Fax:505-922-7406
Practice Address - Street 1:9955 COORS BYPASS NW
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87114-6196
Practice Address - Country:US
Practice Address - Phone:505-922-7409
Practice Address - Fax:505-922-7406
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-30
Last Update Date:2011-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMRP00006183183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist