Provider Demographics
NPI:1043381064
Name:H W PHARMACY INC
Entity Type:Organization
Organization Name:H W PHARMACY INC
Other - Org Name:DAVIS-FLECK UNITED PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RON
Authorized Official - Middle Name:
Authorized Official - Last Name:GOLUBSKI
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:575-894-1079
Mailing Address - Street 1:500 N BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:TRUTH OR CONSEQUENCES
Mailing Address - State:NM
Mailing Address - Zip Code:87901-2729
Mailing Address - Country:US
Mailing Address - Phone:575-894-1079
Mailing Address - Fax:575-894-0585
Practice Address - Street 1:500 N BROADWAY ST
Practice Address - Street 2:
Practice Address - City:TRUTH OR CONSEQUENCES
Practice Address - State:NM
Practice Address - Zip Code:87901-2729
Practice Address - Country:US
Practice Address - Phone:575-894-1079
Practice Address - Fax:575-894-0585
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-13
Last Update Date:2018-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
NMPH000019213336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM2504306Medicaid
NM62035Medicaid
2056746OtherPK
NM55590Medicaid
NM55590Medicaid