Provider Demographics
NPI:1326142381
Name:RURAL RX
Entity Type:Organization
Organization Name:RURAL RX
Other - Org Name:DEMING GOOD NEIGHBOR PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:W
Authorized Official - Middle Name:
Authorized Official - Last Name:SANDERS
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:505-521-1182
Mailing Address - Street 1:PO BOX 1892
Mailing Address - Street 2:
Mailing Address - City:DEMING
Mailing Address - State:NM
Mailing Address - Zip Code:88031-1892
Mailing Address - Country:US
Mailing Address - Phone:575-546-2731
Mailing Address - Fax:575-546-4030
Practice Address - Street 1:820 E FLORIDA ST
Practice Address - Street 2:
Practice Address - City:DEMING
Practice Address - State:NM
Practice Address - Zip Code:88030-5312
Practice Address - Country:US
Practice Address - Phone:575-546-2731
Practice Address - Fax:575-546-4030
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-12
Last Update Date:2012-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMPH00002410333600000X
3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
3206287OtherOTHER ID NUMBER-COMMERCIAL NUMBER
NM64758052Medicaid