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General NPI Number Information
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NPI Number | 1215233820
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Entity Type | Organization
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Legal Business Name | SW MESA CENTER FOR FAMILY AND COMMUNITY HEALTH PHARMACY
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Dates
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Enumeration Date | 01/28/2011
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Last Update Date | 03/13/2014
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Provider Practice Location Address
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Address Line | 301 UNSER BLVD NW STE 106
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City | ALBUQUERQUE
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State | NM
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Zip | 87121-1927
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Country | US
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Telephone | 505-925-4451
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Fax | 505-925-4192
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Provider Business Mailing Address
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Address Line | 301 UNSER BLVD NW STE 106
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City | ALBUQUERQUE
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State | NM
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Zip | 87121-1927
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Country | US
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Telephone | 505-925-4451
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Fax | 505-925-4192
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Authorized Official
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Title or Position | DIRECTOR OF PHARMACY
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Name | FRIEDA ORTEGA
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Credential |
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Telephone | 505-272-0526
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | PH00003240
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License Number State | NM
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