1528445053 NPI number — UNIVERSITY OF NM HOSPITAL RETAIL PHARMACY

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528445053 NPI number — UNIVERSITY OF NM HOSPITAL RETAIL PHARMACY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
UNIVERSITY OF NM HOSPITAL RETAIL PHARMACY
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1528445053
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/05/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2211 LOMAS BLVD NE
Provider Second Line Business Mailing Address:
ATTN: INPATIENT PHARMACY
Provider Business Mailing Address City Name:
ALBUQUERQUE
Provider Business Mailing Address State Name:
NM
Provider Business Mailing Address Postal Code:
87106-2719
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
505-272-2035
Provider Business Mailing Address Fax Number:
505-272-2037

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2211 LOMAS BLVD NE
Provider Second Line Business Practice Location Address:
ATTN: INPATIENT PHARMACY
Provider Business Practice Location Address City Name:
ALBUQUERQUE
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
87106-2719
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
505-272-2035
Provider Business Practice Location Address Fax Number:
505-272-2037
Provider Enumeration Date:
05/05/2015

Additional Information

Authorized Official

Authorized Official Last Name:
LONG
Authorized Official First Name:
WILLIAM
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR OF PHARMACY OPERATION
Authorized Official Telephone Number:
505-272-2035

Provider Taxonomy Codes

  • Taxonomy code: 3336I0012X , with the licence number:  PH00003295 , registered in the state of NM ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 2151529 . This is a "PK" identifier . This identifiers is of the category "OTHER".




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