Healthcare Provider Details

I. General information

NPI: 1295080745
Provider Name (Legal Business Name): PMS DBA CUBA HEALTH CENTER PHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/20/2012
Last Update Date: 07/20/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6349 STATE HWY. 550
CUBA NM
87013
US

IV. Provider business mailing address

6349 STATE HWY. 550
CUBA NM
87013
US

V. Phone/Fax

Practice location:
  • Phone: 575-289-3291
  • Fax: 575-289-3648
Mailing address:
  • Phone: 575-289-3291
  • Fax: 575-289-3648

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: ROBERTA LEE
Title or Position: VICE PRESIDENT OF FINANCE
Credential:
Phone: 505-982-5565