| NPI | 1174607212 |
|---|---|
| Doing Business As | LOVELACE JUAN TABO PHARMACY |
| Entity Type | Organization |
| Authorized Contact | BRAD TROM CEO 505-727-1299 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 3336C0003X Pharmacy Community/Retail Pharmacy (Licence: NM PH00001694) |
| Additional Taxonomies | 333600000X Pharmacy |
| 3336C0002X Pharmacy Clinic Pharmacy | |
| 3336C0004X Pharmacy Compounding Pharmacy | |
| Enumeration Date | 2006-10-25 |
| Last Update Date | 2014-03-19 |