Individual ProviderPerry PedersenPharmacistPharmacy Service ProvidersPractice Address13251 Chaco Canyon Ln NE, Albuquerque, NM 87111-7117(505) 821-5165PECOS EnrollmentBased on the most recent information from CMS, provider Perry Pedersen 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 ID1689280125Provider TypeIndividualFull NamePedersen, PerryCredentialRPHGenderMaleSole ProprietorNoEnumeration Date9/21/2020Last Updated9/21/2020Contact InformationPractice LocationPractice Address13251 Chaco Canyon Ln NE, Albuquerque, NM 87111-7117Phone(505) 821-5165FaxUnlisted FaxMailing LocationMailing Address13251 Chaco Canyon Ln NE, Albuquerque, NM 87111-7117Phone(505) 821-5165FaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode183500000XPrimaryDescriptionPharmacistPharmacy Service ProvidersLicensePH00010684Washington