| NPI | 1013309863 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KENNETH EDWARD COOPER Pharmacist In Charge/Owner 575-541-5030 |
| Organization Subpart ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NM PH000006912) |
| Enumeration Date | 2015-03-02 |
| Last Update Date | 2015-03-02 |