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General NPI Number Information
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NPI Number | 1013309863
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Entity Type | Organization
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Legal Business Name | LAS CRUCES APOTHECARY
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Dates
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Enumeration Date | 03/02/2015
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Last Update Date | 03/02/2015
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Provider Practice Location Address
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Address Line | 525 E MADRID AVE STE 8
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City | LAS CRUCES
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State | NM
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Zip | 88001-1671
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Country | US
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Telephone | 575-541-5030
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Fax |
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Provider Business Mailing Address
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Address Line | 525 E MADRID AVE STE 8
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City | LAS CRUCES
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State | NM
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Zip | 88001-1671
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Country | US
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Telephone | 575-541-5030
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Fax |
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Authorized Official
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Title or Position | PHARMACIST IN CHARGE/OWNER
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Name | DR. KENNETH EDWARD COOPER JR.
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Credential | PHARM.D.
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Telephone | 575-541-5030
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | PH000006912
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License Number State | NM
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