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General NPI Number Information
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NPI Number | 1881727873
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Entity Type | Organization
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Legal Business Name | ACOMA CANONCITO LAGUNA PHARMACY
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Dates
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Enumeration Date | 03/13/2007
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Last Update Date | 02/10/2025
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Provider Practice Location Address
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Address Line | 80 B VETERANS BLVD
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City | ACOMA
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State | NM
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Zip | 87034-8703
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Country | US
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Telephone | 505-552-5393
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Fax | 505-552-5484
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Provider Business Mailing Address
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Address Line | PO BOX 95475
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City | CLEVELAND
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State | OH
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Zip | 44101-0033
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Country | US
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Telephone | 505-552-5394
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Fax | 505-552-5464
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Authorized Official
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Title or Position | CHIEF PHARMACIST
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Name | INNA VOINICH
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Credential | PHARMD
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Telephone | 505-552-5393
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3336I0012X
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Taxonomy Name | Institutional Pharmacy
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 3336S0011X
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Taxonomy Name | Specialty Pharmacy
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 332800000X
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Taxonomy Name | Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy
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License Number |
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License Number State |
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