MEDICARE: SOCORRO SERENO, 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	3336L0003X	Long Term Care Pharmacy
2	3336C0004X	Compounding Pharmacy

General Provider Information

NPI Number	:	1811858061
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOCORRO SERENO, LLC

Provider Business Mailing Address
First Line	:	2705 JUAN TABO BLVD NE STE A4
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87112-1884
Country	:	US
Telephone Number	:	505-225-1873
Fax Number	:

Provider Business Practice Location Address
First Line	:	2705 JUAN TABO BLVD NE STE A4
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87112-1884
Country	:	US
Telephone Number	:	505-225-1873
Fax Number	:

Authorized Official
Title or Position	:	OWNER/PHARMACIST IN CHARGE
Name	:	DR. SHANNON PITCHER
Credential	:	PHARMD
Telephone Number	:	505-225-1873

Provider Enumeration Date	:	11/18/2025
Last Update Date	:	11/18/2025

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Directions to “SOCORRO SERENO, LLC ” Practice Location

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