Healthcare Provider Details

I. General information

NPI: 1619047552
Provider Name (Legal Business Name): SILVER REXALL DRUGS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/08/2006
Last Update Date: 02/08/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1308 SILVER HEIGHTS BLVD
SILVER CITY NM
88061-5528
US

IV. Provider business mailing address

1308 SILVER HEIGHTS BLVD
SILVER CITY NM
88061-5528
US

V. Phone/Fax

Practice location:
  • Phone: 575-388-1579
  • Fax: 575-538-0525
Mailing address:
  • Phone: 575-388-1579
  • Fax: 575-538-0525

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336H0001X
TaxonomyHome Infusion Therapy Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code3336M0003X
TaxonomyManaged Care Organization Pharmacy
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPH00001400
License Number StateNM

VIII. Authorized Official

Name: ALBERT MARTINEZ
Title or Position: PRESIDENT
Credential: PHRM
Phone: 505-388-1579