Healthcare Provider Details

I. General information

NPI: 1265508360
Provider Name (Legal Business Name): PRIME THERAPEUTICS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/28/2006
Last Update Date: 01/18/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4580 PARADISE BLVD NW
ALBUQUERQUE NM
87114-4105
US

IV. Provider business mailing address

PO BOX 27836
ALBUQUERQUE NM
87125-7836
US

V. Phone/Fax

Practice location:
  • Phone: 877-357-7463
  • Fax: 888-215-1811
Mailing address:
  • Phone: 877-357-7463
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336M0002X
TaxonomyMail Order Pharmacy
License NumberPH00002880
License Number StateNM

VIII. Authorized Official

Name: LUGINA MENDEZ-HARPER
Title or Position: DIRECTOR PROFESSIONAL PRACTICES
Credential: PHARMD
Phone: 505-206-1089