Healthcare Provider Details

I. General information

NPI: 1477008324
Provider Name (Legal Business Name): EXPRESS TRADE LC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/22/2016
Last Update Date: 01/22/2026
Certification Date: 01/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1325 EL PASEO RD
LAS CRUCES NM
88001-6023
US

IV. Provider business mailing address

1325 EL PASEO RD
LAS CRUCES NM
88001-6023
US

V. Phone/Fax

Practice location:
  • Phone: 575-915-1538
  • Fax: 575-288-2797
Mailing address:
  • Phone: 575-915-1538
  • Fax: 575-288-2797

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State

VIII. Authorized Official

Name: YAZID ATIEH
Title or Position: OWNER
Credential:
Phone: 575-915-1538