Provider Demographics
NPI:1659997500
Name:RIOGRANDE CARE PHARMACY LLC
Entity Type:Organization
Organization Name:RIOGRANDE CARE PHARMACY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HOSPITALIST
Authorized Official - Prefix:DR
Authorized Official - First Name:RAM MOHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:VENEPALLY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:917-509-0377
Mailing Address - Street 1:4371 E LOHMAN AVE
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88011-8255
Mailing Address - Country:US
Mailing Address - Phone:575-323-3938
Mailing Address - Fax:575-652-3393
Practice Address - Street 1:4371 E LOHMAN AVE
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88011-8255
Practice Address - Country:US
Practice Address - Phone:575-323-3938
Practice Address - Fax:575-652-3393
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-16
Last Update Date:2020-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMPH00005014OtherSTATE BOARD OF PHARMACY