Provider Demographics
NPI:1093851602
Name:PAT-Y-KEN DRUGS INC
Entity Type:Organization
Organization Name:PAT-Y-KEN DRUGS INC
Other - Org Name:THE MEDICINE CHEST
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACY MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARGARITA
Authorized Official - Middle Name:THEREA
Authorized Official - Last Name:WARE
Authorized Official - Suffix:
Authorized Official - Credentials:CPHT
Authorized Official - Phone:505-344-2335
Mailing Address - Street 1:1123 CANDELARIA RD NW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87107-2414
Mailing Address - Country:US
Mailing Address - Phone:505-344-2335
Mailing Address - Fax:505-344-0254
Practice Address - Street 1:1123 CANDELARIA RD NW
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87107-2414
Practice Address - Country:US
Practice Address - Phone:505-344-2335
Practice Address - Fax:505-344-0254
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-30
Last Update Date:2021-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMPH000012143336C0003X
3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2056404OtherPK
NM55939Medicaid
NM55939Medicaid