Healthcare Provider Details

I. General information

NPI: 1013338847
Provider Name (Legal Business Name): FARMER'S UPTOWN PHARMACY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/20/2013
Last Update Date: 12/20/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2800 N MAIN ST
ROSWELL NM
88201-6500
US

IV. Provider business mailing address

2402 W PIERCE ST 2B
CARLSBAD NM
88220-3537
US

V. Phone/Fax

Practice location:
  • Phone: 575-885-4002
  • Fax: 575-885-5714
Mailing address:
  • Phone: 575-885-4002
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MR. NEAL CLIFFORD DUNGAN
Title or Position: OWNER
Credential:
Phone: 575-885-4002