Provider Demographics
NPI:1952852931
Name:CITTY, JERRI R (PHARMD, RPH)
Entity Type:Individual
Prefix:
First Name:JERRI
Middle Name:R
Last Name:CITTY
Suffix:
Gender:F
Credentials:PHARMD, RPH
Other - Prefix:
Other - First Name:JERRI
Other - Middle Name:R
Other - Last Name:ISON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD, RPH
Mailing Address - Street 1:4500 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:NM
Mailing Address - Zip Code:88201-0305
Mailing Address - Country:US
Mailing Address - Phone:575-622-3812
Mailing Address - Fax:
Practice Address - Street 1:4500 N MAIN ST
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:NM
Practice Address - Zip Code:88201-0305
Practice Address - Country:US
Practice Address - Phone:575-622-3812
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-14
Last Update Date:2016-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMRP00006879183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist