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General NPI Number Information
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NPI Number | 1154461341
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Entity Type | Organization
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Legal Business Name | REDE PHARMACY, INC
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Dates
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Enumeration Date | 02/07/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2655 MISSOURI
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City | LAS CRUCES
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State | NM
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Zip | 88011-5023
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Country | US
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Telephone | 505-522-7484
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Fax | 505-522-5652
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Provider Business Mailing Address
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Address Line | 2655 MISSOURI
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City | LAS CRUCES
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State | NM
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Zip | 88011-5023
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Country | US
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Telephone | 505-522-7484
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Fax | 505-522-5652
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Authorized Official
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Title or Position | OWNER-PHARMACIST
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Name | MR. MAHMOOD HURAB
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Credential | RPH
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Telephone | 505-522-7484
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | PH00001746
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License Number State | NM
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