Healthcare Provider Details

I. General information

NPI: 1902358468
Provider Name (Legal Business Name): SOUTHWEST HOME SOLUTIONS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2016
Last Update Date: 06/05/2025
Certification Date: 06/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2100 LOUISIANA BLVD NE STE 460
ALBUQUERQUE NM
87110-5419
US

IV. Provider business mailing address

2100 LOUISIANA BLVD NE STE 460
ALBUQUERQUE NM
87110-5437
US

V. Phone/Fax

Practice location:
  • Phone: 214-404-7787
  • Fax: 214-943-1751
Mailing address:
  • Phone: 505-705-3540
  • Fax: 505-247-0617

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State

VIII. Authorized Official

Name: DR. TISCHA BECKER
Title or Position: PHARMACIST IN CHARGE
Credential:
Phone: 505-705-3540