Healthcare Provider Details

I. General information

NPI: 1215942826
Provider Name (Legal Business Name): LAMC WHITE ROCK PHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/30/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

WHITE ROCK MED CLINIC STE B
WHITE ROCK NM
87544
US

IV. Provider business mailing address

WHITE ROCK MED CLINIC STE B
WHITE ROCK NM
87544
US

V. Phone/Fax

Practice location:
  • Phone: 505-672-3701
  • Fax: 505-672-0369
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License NumberPH00002442
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: ANABEL CANDELARIA
Title or Position: PHARMACY DIR
Credential: PHARM D
Phone: 505-661-9568