MEDICARE: MAY PHARMACY ISLETA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3336C0002X	Clinic Pharmacy
2	3336C0004X	Compounding Pharmacy
3	3336L0003X	Long Term Care Pharmacy
4	3336S0011X	Specialty Pharmacy
5	332B00000X	Durable Medical Equipment & Medical Supplies
6	3336M0003X	Managed Care Organization Pharmacy
7	3336C0003X	Community/Retail Pharmacy	PH00003050	NM

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	3200641	OTHER		NCPDP PROVIDER IDENTIFICATION NUMBER

General Provider Information

NPI Number	:	1336296805
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MAY PHARMACY ISLETA

Provider Business Mailing Address
First Line	:	6300 SAN MATEO BLVD NE
Second Line	:	4C
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87109-3553
Country	:	US
Telephone Number	:	505-828-2348
Fax Number	:	505-828-9266

Provider Business Practice Location Address
First Line	:	1010 BRIDGE BLVD SW
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87105-3765
Country	:	US
Telephone Number	:	505-873-2377
Fax Number	:	505-255-6656

Authorized Official
Title or Position	:	OWNER
Name	:	ALLAN YEH
Credential	:	RPH
Telephone Number	:	805-255-6111

Provider Enumeration Date	:	01/05/2007
Last Update Date	:	06/29/2009

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Directions to “MAY PHARMACY ISLETA ” Practice Location

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