Healthcare Provider Details

I. General information

NPI: 1396095386
Provider Name (Legal Business Name): BEN ARCHER HEALTH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/17/2012
Last Update Date: 04/20/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1998 N MOTEL BLVD BUILDING B
LAS CRUCES NM
88007-4100
US

IV. Provider business mailing address

PO BOX 370
HATCH NM
87937-0370
US

V. Phone/Fax

Practice location:
  • Phone: 575-528-7160
  • Fax: 575-527-9232
Mailing address:
  • Phone: 575-267-3088
  • Fax: 575-267-1747

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPH00003474
License Number StateNM

VIII. Authorized Official

Name: SARAH HARRINGTON
Title or Position: PHARMACY DIRECTOR
Credential: BS OF PHARMACY
Phone: 575-528-7160