Healthcare Provider Details

I. General information

NPI: 1417768094
Provider Name (Legal Business Name): SANDIA PHARMACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/14/2025
Last Update Date: 09/05/2025
Certification Date: 09/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 SAN PEDRO DR SE STE C
ALBUQUERQUE NM
87108-3009
US

IV. Provider business mailing address

201 SAN PEDRO DR SE STE C
ALBUQUERQUE NM
87108-3009
US

V. Phone/Fax

Practice location:
  • Phone: 505-600-2080
  • Fax: 505-600-2088
Mailing address:
  • Phone: 505-600-2080
  • Fax: 505-600-2088

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: CONNIE TSUI
Title or Position: MEMBER
Credential: PHARMD
Phone: 505-600-2080