Healthcare Provider Details

I. General information

NPI: 1043457187
Provider Name (Legal Business Name): SOUTHWEST C A R E CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/12/2009
Last Update Date: 04/20/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

649 HARKLE RD STE C
SANTA FE NM
87505-4765
US

IV. Provider business mailing address

649 HARKLE RD STE C
SANTA FE NM
87505-4765
US

V. Phone/Fax

Practice location:
  • Phone: 505-989-8154
  • Fax: 505-216-0154
Mailing address:
  • Phone: 505-989-8154
  • Fax: 505-216-0154

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty 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 NumberPH00003065
License Number StateNM

VIII. Authorized Official

Name: JEFFREY THOMAS
Title or Position: CEO
Credential:
Phone: 505-989-8200