Provider Demographics
NPI:1497825970
Name:DURAN CENTRAL PHARMACY, INC.
Entity Type:Organization
Organization Name:DURAN CENTRAL PHARMACY, INC.
Other - Org Name:DURAN CENTRAL PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT, AO
Authorized Official - Prefix:
Authorized Official - First Name:MONA
Authorized Official - Middle Name:
Authorized Official - Last Name:GHATTAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-247-4141
Mailing Address - Street 1:1815 CENTRAL AVE NW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87104-1143
Mailing Address - Country:US
Mailing Address - Phone:505-247-4141
Mailing Address - Fax:505-843-6249
Practice Address - Street 1:1815 CENTRAL AVE NW
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87104-1143
Practice Address - Country:US
Practice Address - Phone:505-247-4141
Practice Address - Fax:505-843-6249
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-09
Last Update Date:2021-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0004X
NMPH30873336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2125193OtherPK
NM55699Medicaid
NM55669Medicaid
3946240001Medicare NSC