Healthcare Provider Details

I. General information

NPI: 1699258947
Provider Name (Legal Business Name): MJRX III, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/12/2018
Last Update Date: 02/25/2021
Certification Date: 02/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

151 S WALNUT ST STE A5
LAS CRUCES NM
88001-2613
US

IV. Provider business mailing address

7209 JEFFERSON ST NE
ALBUQUERQUE NM
87109-4307
US

V. Phone/Fax

Practice location:
  • Phone: 575-288-1412
  • Fax: 833-247-2794
Mailing address:
  • Phone: 505-881-4601
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: STEPHEN KOCHERHANS
Title or Position: OWNER
Credential:
Phone: 505-881-4601