Healthcare Provider Details

I. General information

NPI: 1093851602
Provider Name (Legal Business Name): PAT-Y-KEN DRUGS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/30/2007
Last Update Date: 02/18/2021
Certification Date: 02/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1123 CANDELARIA RD NW
ALBUQUERQUE NM
87107-2414
US

IV. Provider business mailing address

1123 CANDELARIA RD NW
ALBUQUERQUE NM
87107-2414
US

V. Phone/Fax

Practice location:
  • Phone: 505-344-2335
  • Fax: 505-344-0254
Mailing address:
  • Phone: 505-344-2335
  • Fax: 505-344-0254

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPH00001214
License Number StateNM

VIII. Authorized Official

Name: MRS. MARGARITA THEREA WARE
Title or Position: PHARMACY MANAGER
Credential: CPHT
Phone: 505-344-2335