Healthcare Provider Details

I. General information

NPI: 1770533440
Provider Name (Legal Business Name): ELPASEO PHARMACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2006
Last Update Date: 10/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1605 EL PASEO RD SUITE A
LAS CRUCES NM
88001-6013
US

IV. Provider business mailing address

1605 EL PASEO RD SUITE A
LAS CRUCES NM
88001-6013
US

V. Phone/Fax

Practice location:
  • Phone: 575-541-1500
  • Fax: 575-541-5929
Mailing address:
  • Phone: 575-541-1500
  • Fax: 575-541-5929

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPH00002812
License Number StateNM

VIII. Authorized Official

Name: ROBERT ADAMS
Title or Position: OWNER
Credential: RPH
Phone: 505-541-1500