| NPI | 1578004438 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ESEOSA EGHAREVBA Pharmacist 575-513-0650 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: NM RP00008666) |
| Enumeration Date | 2017-03-12 |
| Last Update Date | 2017-03-12 |