Healthcare Provider Details

I. General information

NPI: 1467272906
Provider Name (Legal Business Name): ONE CARE PHARMACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2024
Last Update Date: 10/25/2024
Certification Date: 10/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2111 COLLEGE DR UNIT 3
GALLUP NM
87301-5600
US

IV. Provider business mailing address

2111 COLLEGE DR UNIT 3
GALLUP NM
87301-5600
US

V. Phone/Fax

Practice location:
  • Phone: 505-726-4155
  • Fax:
Mailing address:
  • Phone: 505-726-4301
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: MOHANNAD RASHID
Title or Position: CEO
Credential:
Phone: 505-726-4155