Provider Demographics
NPI:1346971256
Name:MESILLA VALLEY PHARMACY & CONSULTING
Entity Type:Organization
Organization Name:MESILLA VALLEY PHARMACY & CONSULTING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:JOAQUIN
Authorized Official - Middle Name:
Authorized Official - Last Name:ACOSTA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:575-635-8417
Mailing Address - Street 1:227 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88001-1290
Mailing Address - Country:US
Mailing Address - Phone:575-323-2093
Mailing Address - Fax:575-323-2095
Practice Address - Street 1:227 S MAIN ST
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88001-1290
Practice Address - Country:US
Practice Address - Phone:575-323-2039
Practice Address - Fax:575-323-2095
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-21
Last Update Date:2022-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM42336236Medicaid