Provider Demographics
NPI:1679677900
Name:ABEYTA ENTERPRISES INC.
Entity Type:Organization
Organization Name:ABEYTA ENTERPRISES INC.
Other - Org Name:RIO DRUGS OF CHAMA
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER/MGR
Authorized Official - Prefix:MR
Authorized Official - First Name:NICK
Authorized Official - Middle Name:D
Authorized Official - Last Name:ABEYTA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-756-2131
Mailing Address - Street 1:PO BOX 976
Mailing Address - Street 2:
Mailing Address - City:CHAMA
Mailing Address - State:NM
Mailing Address - Zip Code:87520-0976
Mailing Address - Country:US
Mailing Address - Phone:505-756-2131
Mailing Address - Fax:505-756-2885
Practice Address - Street 1:612 S. TERRACE AVE.
Practice Address - Street 2:
Practice Address - City:CHAMA
Practice Address - State:NM
Practice Address - Zip Code:87520-0976
Practice Address - Country:US
Practice Address - Phone:505-756-2131
Practice Address - Fax:505-756-2885
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMRP00005580183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMJ0228Medicaid