| NPI | 1366761538 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SCOTT WAYNE WALLIS President 575-524-2863 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336C0004X Pharmacy, Compounding Pharmacy (Licence: NM PH00003193) |
| Enumeration Date | 2010-05-26 |
| Last Update Date | 2010-05-26 |