Individual ProviderJacqueline PhanPharmacistPharmacy Service ProvidersPractice Address8000 Academy Rd NE, Albuquerque, NM 87111-1159(505) 821-6008PECOS EnrollmentBased on the most recent information from CMS, provider Jacqueline Phan 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 ID1699441279Provider TypeIndividualFull NamePhan, JacquelineTitleDr.GenderFemaleSole ProprietorYesEnumeration Date8/23/2021Last Updated8/23/2021Contact InformationPractice LocationPractice Address8000 Academy Rd NE, Albuquerque, NM 87111-1159Phone(505) 821-6008FaxUnlisted FaxMailing LocationMailing Address12417 Rosemont Ave NE, Albuquerque, NM 87112-5723PhoneUnlisted PhoneFaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode183500000XPrimaryDescriptionPharmacistPharmacy Service ProvidersLicenseRP00009545New Mexico