| NPI | 1679891238 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ALFRED VICTOR BACA Pharmacist 575-356-6068 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336C0004X Pharmacy, Compounding Pharmacy (Licence: NM PH00002491) |
| Enumeration Date | 2010-05-06 |
| Last Update Date | 2010-05-06 |