Healthcare Provider Details

I. General information

NPI: 1215233820
Provider Name (Legal Business Name): SW MESA CENTER FOR FAMILY AND COMMUNITY HEALTH PHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/28/2011
Last Update Date: 03/13/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 UNSER BLVD NW STE 106
ALBUQUERQUE NM
87121-1927
US

IV. Provider business mailing address

301 UNSER BLVD NW STE 106
ALBUQUERQUE NM
87121-1927
US

V. Phone/Fax

Practice location:
  • Phone: 505-925-4451
  • Fax: 505-925-4192
Mailing address:
  • Phone: 505-925-4451
  • Fax: 505-925-4192

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPH00003240
License Number StateNM

VIII. Authorized Official

Name: FRIEDA ORTEGA
Title or Position: DIRECTOR OF PHARMACY
Credential:
Phone: 505-272-0526