| NPI | 1164585469 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PHILLIP MCKINNEY Owner 505-325-1855 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336C0003X Pharmacy, Community/Retail Pharmacy |
| Additional Taxonomies | 332B00000X Durable Medical Equipment & Medical Supplies (Licence: NM PH00002581) |
| 3336C0004X Pharmacy, Compounding Pharmacy | |
| 333600000X Pharmacy | |
| Enumeration Date | 2006-12-18 |
| Last Update Date | 2020-08-22 |