Most Relevant Information
Provider Data
| NPI Number: | 1003448895 |
| Provider Name: | JERRY PATRICK ARCHULETA PHARMACIST |
| Entity Type: | Individual |
| Taxonomy Code: | 183500000X |
| Specialty: | Pharmacist |
| License Number: | 11784 |
Most Important Dates
| Enumeration Date: | 02/10/2020 |
| Last Updated: | 02/10/2020 |
Provider Practice Location
1203 MAIN ST
ALAMOSA
CO
811012395
Practice Location Phone/Fax
| Phone: | 7195893165 |
| Fax: | 7195893270 |
Provider Mailing Location
1203 MAIN ST
ALAMOSA
CO
811012395
Provider Mailing Phone/Fax
| Phone: | 7195893165 |
| Fax: | 7195893270 |