1932221231 NPI number — ALBUQUERQUE INDIAN HEALTH CENTER 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 1932221231 NPI number — ALBUQUERQUE INDIAN HEALTH CENTER PHARMACY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ALBUQUERQUE INDIAN HEALTH CENTER 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:
ALBUQUERQUE INDIAN HOSPITAL PHARMACY
Provider Other Organization Name Type Code:
4
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:
1932221231
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
801 VASSAR DR NE
Provider Second Line Business Mailing Address:
PHARMACY DEPARTMENT
Provider Business Mailing Address City Name:
ALBUQUERQUE
Provider Business Mailing Address State Name:
NM
Provider Business Mailing Address Postal Code:
87106-2725
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
505-248-4028
Provider Business Mailing Address Fax Number:
505-248-7642

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
801 VASSAR DR NE
Provider Second Line Business Practice Location Address:
PHARMACY DEPARTMENT
Provider Business Practice Location Address City Name:
ALBUQUERQUE
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
87106-2725
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
505-248-4028
Provider Business Practice Location Address Fax Number:
505-248-7642
Provider Enumeration Date:
04/06/2007

Additional Information

Authorized Official

Authorized Official Last Name:
SOLIS
Authorized Official First Name:
PEDRO
Authorized Official Middle Name:
Authorized Official Title or Position:
PHARMACY DIRECTOR, ACTING
Authorized Official Telephone Number:
505-248-4028

Provider Taxonomy Codes

  • Taxonomy code: 261QP0904X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: EH7890 , issued by the state of ( NM ) . This identifiers is of the category "MEDICAID".




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