Healthcare Provider Details

I. General information

NPI: 1356364343
Provider Name (Legal Business Name): MAY PHARMACY CEDAR CREST INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/25/2006
Last Update Date: 07/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12129 HWY 14 N
CEDAR CREST NM
87008-9492
US

IV. Provider business mailing address

12129 HWY 14 N
CEDAR CREST NM
87008-9492
US

V. Phone/Fax

Practice location:
  • Phone: 505-281-6488
  • Fax: 505-281-6484
Mailing address:
  • Phone: 505-281-6488
  • Fax: 505-281-6484

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License NumberPH00003103
License Number StateNM

VIII. Authorized Official

Name: CONNIE TSUI
Title or Position: PRESIDENT / OWNER
Credential: RPH
Phone: 505-828-2348