MEDICARE: LAMC WHITE ROCK PHARMACY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	333600000X	Pharmacy	PH00002442	NM
2	3336C0003X	Community/Retail Pharmacy

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	3203940	OTHER		OTHER ID NUMBER-COMMERCIAL NUMBER

General Provider Information

NPI Number	:	1215942826
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LAMC WHITE ROCK PHARMACY

Provider Business Mailing Address
First Line	:	WHITE ROCK MED CLINIC STE B
Second Line	:
City	:	WHITE ROCK
State	:	NM
Zip	:	87544
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	WHITE ROCK MED CLINIC STE B
Second Line	:
City	:	WHITE ROCK
State	:	NM
Zip	:	87544
Country	:	US
Telephone Number	:	505-672-3701
Fax Number	:	505-672-0369

Authorized Official
Title or Position	:	PHARMACY DIR
Name	:	ANABEL CANDELARIA
Credential	:	PHARM D
Telephone Number	:	505-661-9568

Provider Enumeration Date	:	07/30/2006
Last Update Date	:	09/11/2025

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