Healthcare Provider Details

I. General information

NPI: 1487726006
Provider Name (Legal Business Name): TKM CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/15/2006
Last Update Date: 01/28/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1275 S 2ND ST SUITE A
RATON NM
87740-2234
US

IV. Provider business mailing address

1275 S 2ND ST SUITE A
RATON NM
87740-2234
US

V. Phone/Fax

Practice location:
  • Phone: 575-445-0075
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPH00001757
License Number StateNM

VIII. Authorized Official

Name: KARIN M MURRAY
Title or Position: OWNER
Credential: RPH
Phone: 575-445-0075