MEDICARE: DEL-REY PHARMACY LLC

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	3336C0003X	Community/Retail Pharmacy	PH00004479	NM

General Provider Information

NPI Number	:	1710404355
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DEL-REY PHARMACY LLC

Provider Business Mailing Address
First Line	:	3291 DEL REY BLVD STE 3
Second Line	:
City	:	LAS CRUCES
State	:	NM
Zip	:	88012-5045
Country	:	US
Telephone Number	:	575-888-4756
Fax Number	:	575-652-4519

Provider Business Practice Location Address
First Line	:	3291 DEL REY BLVD STE 3
Second Line	:
City	:	LAS CRUCES
State	:	NM
Zip	:	88012-5045
Country	:	US
Telephone Number	:	575-888-4756
Fax Number	:	575-652-4519

Authorized Official
Title or Position	:	OWNER
Name	:	MR. KENNETH C OKWUNWANNE
Credential	:
Telephone Number	:	575-888-4756

Provider Enumeration Date	:	08/24/2017
Last Update Date	:	02/09/2026

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