Individual
JORDAN EZEANYIM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHARMD
Contact information
Practice address
1096 S SAINT FRANCIS DR, SANTA FE, NM 87505-1654
(505) 982-9811
Mailing address
2822 ARCE LN SE, RIO RANCHO, NM 87124-3290
(505) 310-0776
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
RP00008752
NM
Other
Enumeration date
08/01/2017
Last updated
08/01/2017
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