Healthcare Provider Details

I. General information

NPI: 1932400397
Provider Name (Legal Business Name): PRESBYTERIAN HEALTHCARE SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/16/2010
Last Update Date: 05/18/2023
Certification Date: 05/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4580 PARADISE BLVD NW
ALBUQUERQUE NM
87114-4105
US

IV. Provider business mailing address

4580 PARADISE BLVD NW
ALBUQUERQUE NM
87114-4105
US

V. Phone/Fax

Practice location:
  • Phone: 505-823-8800
  • Fax: 866-248-0801
Mailing address:
  • Phone: 505-823-8800
  • Fax: 866-248-0801

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336M0002X
TaxonomyMail Order Pharmacy
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License NumberPH00003276
License Number StateNM

VIII. Authorized Official

Name: ERICA DOWNING
Title or Position: VP, PHARMACY AND INFUSION SERVICES
Credential: PHARM D
Phone: 505-724-8994