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General NPI Number Information
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NPI Number | 1881202372
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Entity Type | Organization
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Legal Business Name | MODERN ALCHEMIST COMPOUNDING PHARMACY
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Dates
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Enumeration Date | 07/21/2020
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Last Update Date | 07/21/2020
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Provider Practice Location Address
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Address Line | 7900 SAN PEDRO DR NE
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City | ALBUQUERQUE
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State | NM
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Zip | 87109-4672
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Country | US
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Telephone | 505-200-0033
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Fax | 505-916-0063
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Provider Business Mailing Address
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Address Line | PO BOX 93603
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City | ALBUQUERQUE
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State | NM
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Zip | 87199-3603
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Country | US
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Telephone | 505-200-0033
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Fax | 505-916-0063
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Authorized Official
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Title or Position | CHIEF PHARMACIST
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Name | DR. NAWID FARHAD
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Credential | PHARMD
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Telephone | 505-200-0033
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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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