Healthcare Provider Details

I. General information

NPI: 1154461341
Provider Name (Legal Business Name): REDE PHARMACY, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/07/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2655 MISSOURI
LAS CRUCES NM
88011-5023
US

IV. Provider business mailing address

2655 MISSOURI
LAS CRUCES NM
88011-5023
US

V. Phone/Fax

Practice location:
  • Phone: 505-522-7484
  • Fax: 505-522-5652
Mailing address:
  • Phone: 505-522-7484
  • Fax: 505-522-5652

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPH00001746
License Number StateNM

VIII. Authorized Official

Name: MR. MAHMOOD HURAB
Title or Position: OWNER-PHARMACIST
Credential: RPH
Phone: 505-522-7484