Provider Demographics
NPI:1962658096
Name:CITO, JO MARIE (RPH)
Entity Type:Individual
Prefix:MS
First Name:JO
Middle Name:MARIE
Last Name:CITO
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 1:1815 CENTRAL AVE NW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87104-1143
Mailing Address - Country:US
Mailing Address - Phone:505-247-4141
Mailing Address - Fax:505-843-6472
Practice Address - Street 1:1815 CENTRAL AVE NW
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87104-1143
Practice Address - Country:US
Practice Address - Phone:505-247-4141
Practice Address - Fax:505-843-6472
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-08
Last Update Date:2008-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM3839183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist