Healthcare Provider Details

I. General information

NPI: 1710550975
Provider Name (Legal Business Name): HILLRISE PHARMACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/23/2021
Last Update Date: 07/23/2021
Certification Date: 07/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2906 HILLRISE DR
LAS CRUCES NM
88011-4702
US

IV. Provider business mailing address

2906 HILLRISE DR
LAS CRUCES NM
88011-4702
US

V. Phone/Fax

Practice location:
  • Phone: 575-652-4499
  • Fax: 575-323-3036
Mailing address:
  • Phone: 575-652-4499
  • Fax: 575-323-3036

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MR. SATISH YELAMANCHILI
Title or Position: OWNER
Credential:
Phone: 816-699-1889