Healthcare Provider Details

I. General information

NPI: 1487034591
Provider Name (Legal Business Name): SOUTHWEST CARE CENTER PHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/03/2015
Last Update Date: 05/09/2022
Certification Date: 09/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4710 JEFFERSON ST NE SUITE A
ALBUQUERQUE NM
87109-2155
US

IV. Provider business mailing address

4710 JEFFERSON ST NE SUITE A
ALBUQUERQUE NM
87109-2155
US

V. Phone/Fax

Practice location:
  • Phone: 505-780-4044
  • Fax:
Mailing address:
  • Phone: 505-780-4044
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code208U00000X
TaxonomyClinical Pharmacology Physician
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL ADAMS
Title or Position: CEO
Credential:
Phone: 505-989-8200