MEDICARE: SILVER REXALL DRUGS INC

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	3336H0001X	Home Infusion Therapy Pharmacy
2	332B00000X	Durable Medical Equipment & Medical Supplies
3	3336C0004X	Compounding Pharmacy
4	3336M0003X	Managed Care Organization Pharmacy
5	333600000X	Pharmacy
6	3336C0003X	Community/Retail Pharmacy	PH00001400	NM

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	3203697	OTHER		NCPDP PROVIDER IDENTIFICATION NUMBER

General Provider Information

NPI Number	:	1619047552
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SILVER REXALL DRUGS INC

Provider Business Mailing Address
First Line	:	1308 SILVER HEIGHTS BLVD
Second Line	:
City	:	SILVER CITY
State	:	NM
Zip	:	88061-5528
Country	:	US
Telephone Number	:	575-388-1579
Fax Number	:	575-538-0525

Provider Business Practice Location Address
First Line	:	1308 SILVER HEIGHTS BLVD
Second Line	:
City	:	SILVER CITY
State	:	NM
Zip	:	88061-5528
Country	:	US
Telephone Number	:	575-388-1579
Fax Number	:	575-538-0525

Authorized Official
Title or Position	:	PRESIDENT
Name	:	ALBERT MARTINEZ
Credential	:	PHRM
Telephone Number	:	505-388-1579

Provider Enumeration Date	:	11/08/2006
Last Update Date	:	02/08/2012

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Directions to “SILVER REXALL DRUGS INC ” Practice Location

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