Healthcare Provider Details

I. General information

NPI: 1932960556
Provider Name (Legal Business Name): TRIANGLE PHARMACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/22/2024
Last Update Date: 01/22/2024
Certification Date: 01/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12165 N HIGHWAY 14
CEDAR CREST NM
87008-9461
US

IV. Provider business mailing address

1133 TRACY PL
CARLSBAD NM
88220-5270
US

V. Phone/Fax

Practice location:
  • Phone: 505-886-9905
  • Fax: 505-886-9906
Mailing address:
  • Phone: 575-361-6841
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State

VIII. Authorized Official

Name: JOSPEH DANIEL CROSS
Title or Position: PARTNER
Credential: RPH
Phone: 575-361-6841