Healthcare Provider Details

I. General information

NPI: 1962568386
Provider Name (Legal Business Name): GHAFFARI MEDICAL PHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/29/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

815 W 14TH ST
CLOVIS NM
88101-5514
US

IV. Provider business mailing address

121 W 5TH ST
CLOVIS NM
88101-7301
US

V. Phone/Fax

Practice location:
  • Phone: 505-762-3294
  • Fax: 505-763-0062
Mailing address:
  • Phone: 505-762-3294
  • Fax: 505-763-0062

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number85025038
License Number StateNM

VIII. Authorized Official

Name: MS. LINDA R GHAFFARI
Title or Position: OWNER
Credential:
Phone: 505-749-2915