Provider Demographics
NPI:1528336542
Name:NELSON, ROBERT MARK JR (PHARMD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:MARK
Last Name:NELSON
Suffix:JR
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4221 BROADMOOR AVE NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87108-1103
Mailing Address - Country:US
Mailing Address - Phone:505-573-0441
Mailing Address - Fax:
Practice Address - Street 1:10700 UNSER BLVD NW
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87114-4640
Practice Address - Country:US
Practice Address - Phone:505-792-1992
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-05
Last Update Date:2011-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMRP00007720183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist