Healthcare Provider Details

I. General information

NPI: 1568005262
Provider Name (Legal Business Name): BENJAMIN CRUZ ARENAS PHARM.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/25/2019
Last Update Date: 10/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

117 CAMINO DE VIDA STE 200
SANTA ROSA NM
88435-2267
US

IV. Provider business mailing address

117 CAMINO DE VIDA STE 200
SANTA ROSA NM
88435-2267
US

V. Phone/Fax

Practice location:
  • Phone: 575-472-5666
  • Fax: 575-472-9666
Mailing address:
  • Phone: 575-472-5666
  • Fax: 575-472-9666

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP00008760
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: