| NPI | 1063815231 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LESLIE WEIDLOCKER Pharmacy Supervisor 505-983-5546 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: NM 00004647) |
| Enumeration Date | 2014-10-02 |
| Last Update Date | 2014-10-02 |