MEDICARE: PRESBYTERIAN HEALTHCARE SERVICES

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	333600000X	Pharmacy
2	3336C0003X	Community/Retail Pharmacy
3	3336M0002X	Mail Order Pharmacy
4	3336S0011X	Specialty Pharmacy	PH00003276	NM

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2127585	OTHER		PK

General Provider Information

NPI Number	:	1932400397
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PRESBYTERIAN HEALTHCARE SERVICES

Provider Business Mailing Address
First Line	:	4580 PARADISE BLVD NW
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87114-4105
Country	:	US
Telephone Number	:	505-823-8800
Fax Number	:	866-248-0801

Provider Business Practice Location Address
First Line	:	4580 PARADISE BLVD NW
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87114-4105
Country	:	US
Telephone Number	:	505-823-8800
Fax Number	:	866-248-0801

Authorized Official
Title or Position	:	VP, PHARMACY AND INFUSION SERVICES
Name	:	ERICA DOWNING
Credential	:	PHARM D
Telephone Number	:	505-724-8994

Provider Enumeration Date	:	11/16/2010
Last Update Date	:	05/18/2023

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Directions to “PRESBYTERIAN HEALTHCARE SERVICES ” Practice Location

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