Healthcare Provider Details

I. General information

NPI: 1306022249
Provider Name (Legal Business Name): GHAFFARI MEDICAL PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/10/2008
Last Update Date: 01/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2929 N COORS NW 3RD FLOOR STE 310H
ALBUQUERQUE NM
87120
US

IV. Provider business mailing address

121 W 5TH ST
CLOVIS NM
88101-7301
US

V. Phone/Fax

Practice location:
  • Phone: 505-836-4801
  • Fax: 505-836-4801
Mailing address:
  • Phone: 505-749-2915
  • Fax: 575-763-0062

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MISS LINDA ROSE GHAFFARI
Title or Position: CEO
Credential:
Phone: 505-749-2915