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General NPI Number Information
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NPI Number | 1962568386
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Entity Type | Organization
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Legal Business Name | GHAFFARI MEDICAL PHARMACY
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Dates
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Enumeration Date | 12/29/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 815 W 14TH ST
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City | CLOVIS
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State | NM
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Zip | 88101-5514
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Country | US
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Telephone | 505-762-3294
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Fax | 505-763-0062
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Provider Business Mailing Address
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Address Line | 121 W 5TH ST
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City | CLOVIS
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State | NM
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Zip | 88101-7301
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Country | US
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Telephone | 505-762-3294
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Fax | 505-763-0062
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Authorized Official
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Title or Position | OWNER
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Name | MS. LINDA R GHAFFARI
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Credential |
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Telephone | 505-749-2915
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 85025038
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License Number State | NM
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