Healthcare Provider Details

I. General information

NPI: 1609873900
Provider Name (Legal Business Name): LOWELLS PHARMACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/30/2005
Last Update Date: 02/20/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

612 N 13TH ST STE A
ARTESIA NM
88210-1112
US

IV. Provider business mailing address

612 N 13TH ST STE A
ARTESIA NM
88210-1112
US

V. Phone/Fax

Practice location:
  • Phone: 575-746-6681
  • Fax: 575-746-6647
Mailing address:
  • Phone: 575-746-6681
  • Fax: 575-746-6647

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPH00001211
License Number StateNM

VIII. Authorized Official

Name: LOWELL IRBY
Title or Position: OWNER/PIC
Credential: RPH
Phone: 575-746-6681