Healthcare Provider Details

I. General information

NPI: 1811858061
Provider Name (Legal Business Name): SOCORRO SERENO, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/18/2025
Last Update Date: 11/18/2025
Certification Date: 11/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2705 JUAN TABO BLVD NE STE A4
ALBUQUERQUE NM
87112-1884
US

IV. Provider business mailing address

2705 JUAN TABO BLVD NE STE A4
ALBUQUERQUE NM
87112-1884
US

V. Phone/Fax

Practice location:
  • Phone: 505-225-1873
  • Fax:
Mailing address:
  • Phone: 505-225-1873
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: DR. SHANNON PITCHER
Title or Position: OWNER/PHARMACIST IN CHARGE
Credential: PHARMD
Phone: 505-225-1873