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General NPI Number Information
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NPI Number | 1528259124
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Entity Type | Organization
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Legal Business Name | LA CASA FAMILY HEALTH CENTER
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Dates
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Enumeration Date | 08/08/2007
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Last Update Date | 08/08/2007
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Provider Practice Location Address
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Address Line | 1521 W 13TH ST
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City | CLOVIS
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State | NM
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Zip | 88101-5568
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Country | US
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Telephone | 505-769-0227
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Fax | 505-763-9154
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Provider Business Mailing Address
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Address Line | 1521 W 13TH ST
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City | CLOVIS
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State | NM
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Zip | 88101-5568
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Country | US
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Telephone | 505-769-0227
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Fax | 505-763-9154
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Authorized Official
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Title or Position | DIRECTOR OF PHARMACY SERVICES
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Name | MRS. MELISSA C. RAINS
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Credential | RPH
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Telephone | 505-769-0888
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0002X
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Taxonomy Name | Clinic Pharmacy
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License Number | PH00001877
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License Number State | NM
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