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NPI Code Detail

MEDICARE: LA FARMACIA

MEDICARE: LA FARMACIA
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
1333600000XPharmacyPH00001142NM
23336C0003XCommunity/Retail Pharmacy

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
13205817OTHEROTHER ID NUMBER-COMMERCIAL NUMBER
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1477564029
Entity Type Code : Organization
Provider Name (Legal Business Name) : LA FARMACIA
Provider Business Mailing Address
First Line : PO 3708 FAIRVIEW STATION
Second Line :
City : ESPANOLA
State : NM
Zip : 87532
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 544 N PASEO DE ONATE
Second Line :
City : ESPANOLA
State : NM
Zip : 87532-2618
Country : US
Telephone Number : 505-753-2327
Fax Number :
Authorized Official
Title or Position : OWNER MGR
Name : LEO WINK
Credential : RPH
Telephone Number : 505-753-2327
Provider Enumeration Date : 08/10/2006
Last Update Date : 09/11/2025

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Directions to “LA FARMACIA ” Practice Location

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