Provider Demographics
NPI:1780286609
Name:BORUNDA DUQUE, TEOFILO (PHARMD)
Entity type:Individual
Prefix:
First Name:TEOFILO
Middle Name:
Last Name:BORUNDA DUQUE
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 1:1001 WOODWARD PL NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87102-2705
Mailing Address - Country:US
Mailing Address - Phone:505-938-8071
Mailing Address - Fax:
Practice Address - Street 1:1001 WOODWARD PL NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87102-2705
Practice Address - Country:US
Practice Address - Phone:505-938-8071
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-16
Last Update Date:2020-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMRP00008993183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist