Provider Demographics
NPI:1427315274
Name:RAMIREZ, ELISEO (CPHT, BSIT)
Entity type:Individual
Prefix:MR
First Name:ELISEO
Middle Name:
Last Name:RAMIREZ
Suffix:
Gender:M
Credentials:CPHT, BSIT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:418 S COUNTY LINE DR
Mailing Address - Street 2:
Mailing Address - City:CHAPARRAL
Mailing Address - State:NM
Mailing Address - Zip Code:88081-7801
Mailing Address - Country:US
Mailing Address - Phone:915-694-4205
Mailing Address - Fax:575-824-8208
Practice Address - Street 1:111 W LISA DR STE B
Practice Address - Street 2:
Practice Address - City:CHAPARRAL
Practice Address - State:NM
Practice Address - Zip Code:88081-7458
Practice Address - Country:US
Practice Address - Phone:915-694-4205
Practice Address - Fax:575-824-8208
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-18
Last Update Date:2012-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMPT00004947183700000X
NMCOMPTIA ANSP247000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician
No247000000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Health Information
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM410101070950839OtherPHARMACY TECHNICIAN CERTIFICATION BOARD