Healthcare Provider Details

I. General information

NPI: 1295847200
Provider Name (Legal Business Name): DRAGGON DRUG INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1377 DIAMOND DR
LOS ALAMOS NM
87544-2218
US

IV. Provider business mailing address

PO BOX 1243
LOS ALAMOS NM
87544-1243
US

V. Phone/Fax

Practice location:
  • Phone: 505-662-6189
  • Fax: 505-662-3171
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License NumberPH00001162
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: GEORGE ANDERSON
Title or Position: PRESIDENT
Credential:
Phone: 505-662-6189