Provider Demographics
NPI:1780817239
Name:DELGADO, MATTHEW R (PHARMD)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:R
Last Name:DELGADO
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:955 N WHITE SANDS BLVD
Mailing Address - Street 2:
Mailing Address - City:ALAMOGORDO
Mailing Address - State:NM
Mailing Address - Zip Code:88310-6925
Mailing Address - Country:US
Mailing Address - Phone:575-434-4116
Mailing Address - Fax:575-434-4579
Practice Address - Street 1:955 N WHITE SANDS BLVD
Practice Address - Street 2:
Practice Address - City:ALAMOGORDO
Practice Address - State:NM
Practice Address - Zip Code:88310-6925
Practice Address - Country:US
Practice Address - Phone:575-434-4116
Practice Address - Fax:575-434-4579
Is Sole Proprietor?:No
Enumeration Date:2009-09-01
Last Update Date:2009-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMRP00007027183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMRP00007027OtherPHARMACY IMMUNIZATIONS