Healthcare Provider Details

I. General information

NPI: 1679329783
Provider Name (Legal Business Name): PHARMTRUE PHARMACY DTLC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/29/2024
Last Update Date: 04/29/2024
Certification Date: 04/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

227 S MAIN ST
LAS CRUCES NM
88001-1290
US

IV. Provider business mailing address

227 S MAIN ST
LAS CRUCES NM
88001-1290
US

V. Phone/Fax

Practice location:
  • Phone: 575-993-5243
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: DR. JOAQUIN ACOSTA
Title or Position: CEO
Credential: PHARMD, MBA
Phone: 575-993-5243