Provider Demographics
NPI:1821321464
Name:GABALDON-SAUTER, JOANN K
Entity Type:Individual
Prefix:MRS
First Name:JOANN
Middle Name:K
Last Name:GABALDON-SAUTER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4051 SOUTHERN BLVD SE
Mailing Address - Street 2:
Mailing Address - City:RIO RANCHO
Mailing Address - State:NM
Mailing Address - Zip Code:87124-2069
Mailing Address - Country:US
Mailing Address - Phone:505-892-6690
Mailing Address - Fax:505-892-8244
Practice Address - Street 1:4051 SOUTHERN BLVD SE
Practice Address - Street 2:
Practice Address - City:RIO RANCHO
Practice Address - State:NM
Practice Address - Zip Code:87124-2069
Practice Address - Country:US
Practice Address - Phone:505-892-6690
Practice Address - Fax:505-892-8244
Is Sole Proprietor?:No
Enumeration Date:2009-09-15
Last Update Date:2009-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM5428183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist