Provider Demographics
NPI:1518248285
Name:AGBEMADZO, RITA A (RPH)
Entity Type:Individual
Prefix:MRS
First Name:RITA
Middle Name:A
Last Name:AGBEMADZO
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 1:500 ALBINO RD
Mailing Address - Street 2:
Mailing Address - City:CORRALES
Mailing Address - State:NM
Mailing Address - Zip Code:87048-8536
Mailing Address - Country:US
Mailing Address - Phone:505-896-8050
Mailing Address - Fax:
Practice Address - Street 1:4300 RIDGECREST DR SE
Practice Address - Street 2:
Practice Address - City:RIO RANCHO
Practice Address - State:NM
Practice Address - Zip Code:87124-5911
Practice Address - Country:US
Practice Address - Phone:505-892-2262
Practice Address - Fax:595-892-1163
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-07
Last Update Date:2011-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMRP 7582183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist