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General NPI Number Information
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NPI Number | 1578503488
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Entity Type | Organization
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Legal Business Name | MOUNTAINAIR MEDS & MORE, LLC
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Dates
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Enumeration Date | 06/08/2006
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Last Update Date | 08/17/2018
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Provider Practice Location Address
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Address Line | 111 W. BROADWAY
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City | MOUNTAINAIR
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State | NM
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Zip | 87036
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Country | US
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Telephone | 505-847-0242
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Fax | 505-847-0252
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Provider Business Mailing Address
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Address Line | PO BOX 969
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City | MOUNTAINAIR
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State | NM
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Zip | 87036-0969
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Country | US
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Telephone | 505-847-0242
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Fax | 505-847-0252
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Authorized Official
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Title or Position | CO-OWNER
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Name | MS. KATHLEEN ALEXANDRA WEST
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Credential | RPH
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Telephone | 505-847-0242
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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 | RP00006163
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License Number State | NM
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