Provider Demographics
NPI:1437933579
Name:MONTANEZ, JOSE ANTONIO III (RPH)
Entity type:Individual
Prefix:
First Name:JOSE
Middle Name:ANTONIO
Last Name:MONTANEZ
Suffix:III
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 1:600 POSADA CT SE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87123-4509
Mailing Address - Country:US
Mailing Address - Phone:505-340-8100
Mailing Address - Fax:
Practice Address - Street 1:7850 ENCHANTED HILLS BLVD NE
Practice Address - Street 2:
Practice Address - City:RIO RANCHO
Practice Address - State:NM
Practice Address - Zip Code:87144-8623
Practice Address - Country:US
Practice Address - Phone:505-771-2777
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-21
Last Update Date:2024-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMRP00009991183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist