Provider Demographics
NPI:1912122946
Name:GRIEGO, MOISES PHIL (PRH)
Entity Type:Individual
Prefix:
First Name:MOISES
Middle Name:PHIL
Last Name:GRIEGO
Suffix:
Gender:M
Credentials:PRH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5510 LOMAS BLVD NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87110-6545
Mailing Address - Country:US
Mailing Address - Phone:505-265-6868
Mailing Address - Fax:505-256-9196
Practice Address - Street 1:5510 LOMAS BLVD NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87110-6545
Practice Address - Country:US
Practice Address - Phone:505-265-6868
Practice Address - Fax:505-256-9196
Is Sole Proprietor?:No
Enumeration Date:2007-04-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM3957183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist