Healthcare Provider Details

I. General information

NPI: 1710404355
Provider Name (Legal Business Name): DEL-REY PHARMACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/24/2017
Last Update Date: 02/09/2026
Certification Date: 02/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3291 DEL REY BLVD STE 3
LAS CRUCES NM
88012-5045
US

IV. Provider business mailing address

3291 DEL REY BLVD STE 3
LAS CRUCES NM
88012-5045
US

V. Phone/Fax

Practice location:
  • Phone: 575-888-4756
  • Fax: 575-652-4519
Mailing address:
  • Phone: 575-888-4756
  • Fax: 575-652-4519

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPH00004479
License Number StateNM

VIII. Authorized Official

Name: MR. KENNETH C OKWUNWANNE
Title or Position: OWNER
Credential:
Phone: 575-888-4756