Healthcare Provider Details

I. General information

NPI: 1366985186
Provider Name (Legal Business Name): ALBERTSONS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/28/2016
Last Update Date: 11/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1285 EL PASEO RD
LAS CRUCES NM
88001-6000
US

IV. Provider business mailing address

4993 BERYL ST
LAS CRUCES NM
88012-9447
US

V. Phone/Fax

Practice location:
  • Phone: 575-541-1264
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number8598
License Number StateNM

VIII. Authorized Official

Name: VALERIE HANWAY
Title or Position: PHARMACIST
Credential: PHARMD
Phone: 575-571-3638