Provider Demographics
NPI:1053599712
Name:ATENCIO, ARMANDO J SR (RPH)
Entity type:Individual
Prefix:
First Name:ARMANDO
Middle Name:J
Last Name:ATENCIO
Suffix:SR
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 TRAMWAY S.E.
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87123
Mailing Address - Country:US
Mailing Address - Phone:505-296-9751
Mailing Address - Fax:
Practice Address - Street 1:200 TRAMWAY BLVD SE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87123-3934
Practice Address - Country:US
Practice Address - Phone:505-296-9751
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-05
Last Update Date:2008-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM4235183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM4235OtherNEW MEXICO LICENSE NUMBER