Healthcare Provider Details

I. General information

NPI: 1851086557
Provider Name (Legal Business Name): SOCORRO COMMUNITY PHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/07/2023
Last Update Date: 05/15/2023
Certification Date: 05/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 N CALIFORNIA ST
SOCORRO NM
87801-4203
US

IV. Provider business mailing address

PO BOX 433
SOCORRO NM
87801-0433
US

V. Phone/Fax

Practice location:
  • Phone: 575-322-2117
  • Fax: 575-446-0073
Mailing address:
  • Phone: 575-322-2117
  • Fax: 575-322-2454

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: MRS. CHRISTINA R ELSWICK
Title or Position: OWNER
Credential:
Phone: 575-491-3255