Healthcare Provider Details

I. General information

NPI: 1386655934
Provider Name (Legal Business Name): FMC PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2006
Last Update Date: 06/04/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1676 HOSPITAL DR
SANTA FE NM
87505-4754
US

IV. Provider business mailing address

560 N BEVERLY GLEN BLVD
LOS ANGELES CA
90077-3504
US

V. Phone/Fax

Practice location:
  • Phone: 505-983-4359
  • Fax: 505-983-5259
Mailing address:
  • Phone: 310-556-4422
  • Fax: 310-276-9414

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPH00003035
License Number StateNM

VIII. Authorized Official

Name: TERRY CATER
Title or Position: PHARMACY EXECUTIVE
Credential: RPH
Phone: 925-895-1506