Healthcare Provider Details

I. General information

NPI: 1730287749
Provider Name (Legal Business Name): UNITED DRUG & LIQUOR INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2006
Last Update Date: 06/21/2025
Certification Date: 06/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

221 W HALL ST
HATCH NM
87937-0427
US

IV. Provider business mailing address

PO BOX 427
HATCH NM
87937-0427
US

V. Phone/Fax

Practice location:
  • Phone: 575-267-4943
  • Fax: 575-267-3327
Mailing address:
  • Phone: 575-267-4943
  • Fax: 575-267-3327

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPH00001373
License Number StateNM

VIII. Authorized Official

Name: GREG MITCHELL
Title or Position: PRESIDENT
Credential:
Phone: 575-267-4943