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General NPI Number Information
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NPI Number | 1942615570
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Entity Type | Organization
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Legal Business Name | PRESBYTERIAN HEALTHCARE SERVICES
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Dates
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Enumeration Date | 06/23/2014
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 2401 W. 21ST ST
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City | CLOVIS
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State | NM
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Zip | 88101
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Country | US
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Telephone | 575-769-7680
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Fax | 575-769-7156
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Provider Business Mailing Address
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Address Line | 2401 W. 21ST ST
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City | CLOVIS
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State | NM
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Zip | 88101
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Country | US
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Telephone | 575-769-7541
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Fax | 575-769-7156
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Authorized Official
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Title or Position | PROVIDER ENROLLMENT MANAGER
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Name | KIMBERLY POLAND
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Credential |
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Telephone | 505-923-5355
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | PH00003710
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License Number State | NM
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