Individual ProviderJuanita M NellosPharmacistPharmacy Service ProvidersPractice Address12201 Academy Rd NE, Albuquerque, NM 87111-8051(505) 275-9733PECOS EnrollmentBased on the most recent information from CMS, provider Juanita M Nellos does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records today at 9:43 AM.Profile DetailsProvider ID1114271574Provider TypeIndividualFull NameNellos, Juanita MCredentialRPHGenderFemaleSole ProprietorYesEnumeration Date11/6/2012Last Updated11/6/2012Contact InformationPractice LocationPractice Address12201 Academy Rd NE, Albuquerque, NM 87111-8051Phone(505) 275-9733FaxUnlisted FaxMailing LocationMailing Address12201 Academy Rd NE, Albuquerque, NM 87111-8051Phone(505) 275-9733FaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode183500000XPrimaryDescriptionPharmacistPharmacy Service ProvidersLicenseRP00003593New MexicoProvider IdentifiersIDDescriptionIssuerID440629DescriptionOtherIssuerNABPNew Mexico