Provider Demographics
NPI:1710404355
Name:DEL-REY PHARMACY LLC
Entity Type:Organization
Organization Name:DEL-REY PHARMACY LLC
Other - Org Name:DEL-REY PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:C
Authorized Official - Last Name:OKWUNWANNE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:575-888-4756
Mailing Address - Street 1:596 PAT CRUZ
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79932-4107
Mailing Address - Country:US
Mailing Address - Phone:915-261-9713
Mailing Address - Fax:
Practice Address - Street 1:3291 DEL REY BLVD STE 3
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88012-5045
Practice Address - Country:US
Practice Address - Phone:575-888-4756
Practice Address - Fax:575-652-4519
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-24
Last Update Date:2017-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMPH000044793336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy