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General NPI Number Information
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NPI Number | 1285924803
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Entity Type | Organization
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Legal Business Name | COMPLETE CARE PHARMACY LLC
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Dates
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Enumeration Date | 04/15/2011
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Last Update Date | 01/13/2017
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Provider Practice Location Address
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Address Line | 4940 CORRALES RD SUITE 200
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City | CORRALES
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State | NM
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Zip | 87048-8673
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Country | US
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Telephone | 505-897-3784
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Fax | 505-897-3795
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Provider Business Mailing Address
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Address Line | 4940 CORRALES RD SUITE 200
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City | CORRALES
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State | NM
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Zip | 87048-8673
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Country | US
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Telephone | 505-897-3784
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Fax | 505-897-3795
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Authorized Official
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Title or Position | OWNER,PIC,AO
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Name | MIKE GALLEGOS
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Credential | PHARMD,RPH
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Telephone | 505-897-3784
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0004X
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Taxonomy Name | Compounding 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 | PH00004048
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License Number State | NM
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