Healthcare Provider Details

I. General information

NPI: 1497825970
Provider Name (Legal Business Name): DURAN CENTRAL PHARMACY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/09/2006
Last Update Date: 01/11/2021
Certification Date: 01/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1815 CENTRAL AVE NW
ALBUQUERQUE NM
87104-1143
US

IV. Provider business mailing address

1815 CENTRAL AVE NW
ALBUQUERQUE NM
87104-1143
US

V. Phone/Fax

Practice location:
  • Phone: 505-247-4141
  • Fax: 505-843-6249
Mailing address:
  • Phone: 505-247-4141
  • Fax: 505-843-6249

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 NumberPH3087
License Number StateNM
# 3
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: MONA GHATTAS
Title or Position: PRESIDENT, AO
Credential:
Phone: 505-247-4141