| NPI | 1629145792 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BEAU BAUMANN Administrator 505-623-3311 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336C0003X Pharmacy, Community/Retail Pharmacy (Licence: NM PH00001203) |
| Additional Taxonomies | 333600000X Pharmacy |
| Enumeration Date | 2006-11-30 |
| Last Update Date | 2007-09-13 |