Provider Demographics
NPI:1104178201
Name:LBH PHARMACY LLC
Entity Type:Organization
Organization Name:LBH PHARMACY LLC
Other - Org Name:CENTRAL PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LOAN
Authorized Official - Middle Name:
Authorized Official - Last Name:HA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-363-3706
Mailing Address - Street 1:7226 CENTRAL AVE SE STE I
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87108-2000
Mailing Address - Country:US
Mailing Address - Phone:505-508-4272
Mailing Address - Fax:505-508-3988
Practice Address - Street 1:7226 CENTRAL AVE SE STE I
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87108-2000
Practice Address - Country:US
Practice Address - Phone:505-508-4272
Practice Address - Fax:505-508-3988
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-12
Last Update Date:2013-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMPH000034723336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM12208272Medicaid
2138652OtherPK