=====================================================
General NPI Number Information
=====================================================
NPI Number | 1861580763
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BEN ARCHER HEALTH CENTER
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/10/2006
-----------------------------------------------------
Last Update Date | 04/20/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1600 THORPE RD
-----------------------------------------------------
City | LAS CRUCES
-----------------------------------------------------
State | NM
-----------------------------------------------------
Zip | 88012-9776
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 575-382-6812
-----------------------------------------------------
Fax | 575-373-9549
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 370
-----------------------------------------------------
City | HATCH
-----------------------------------------------------
State | NM
-----------------------------------------------------
Zip | 87937-0370
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 575-267-3088
-----------------------------------------------------
Fax | 575-267-1747
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PHARMACY DIRECTOR
-----------------------------------------------------
Name | SARAH HARRINGTON
-----------------------------------------------------
Credential | R.PH.
-----------------------------------------------------
Telephone | 575-382-6812
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 333600000X
-----------------------------------------------------
Taxonomy Name | Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number | PH00001958
-----------------------------------------------------
License Number State | NM
-----------------------------------------------------