Provider Demographics
NPI:1518292630
Name:JUARROS, DAVID ALBERT (BS)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:ALBERT
Last Name:JUARROS
Suffix:
Gender:M
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3701 CONSTITUTION AVE NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87110-5623
Mailing Address - Country:US
Mailing Address - Phone:505-256-9443
Mailing Address - Fax:505-268-8173
Practice Address - Street 1:3701 CONSTITUTION AVE NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87110-5623
Practice Address - Country:US
Practice Address - Phone:505-256-9443
Practice Address - Fax:505-268-8173
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-07
Last Update Date:2009-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMRP00005470183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist