Individual
JORDAN VERMILLION
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
12201 ACADEMY RD NE, ALBUQUERQUE, NM 87111-8051
(505) 275-9733
Mailing address
12201 ACADEMY RD NE, ALBUQUERQUE, NM 87111-8051
(505) 275-9733
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
RP00009169
NM
Other
Enumeration date
08/19/2019
Last updated
08/19/2019
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