Provider Demographics
NPI:1790384261
Name:MT. CRISTO PHARMACY LLC
Entity Type:Organization
Organization Name:MT. CRISTO PHARMACY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MEHRDAD
Authorized Official - Middle Name:
Authorized Official - Last Name:POURJAVAHERI
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:575-332-9393
Mailing Address - Street 1:1155 MCNUTT RD
Mailing Address - Street 2:SUITE110
Mailing Address - City:SUNLAND PARK
Mailing Address - State:NM
Mailing Address - Zip Code:88063-8148
Mailing Address - Country:US
Mailing Address - Phone:575-332-9393
Mailing Address - Fax:
Practice Address - Street 1:1155 MCNUTT RD STE 110
Practice Address - Street 2:
Practice Address - City:SUNLAND PARK
Practice Address - State:NM
Practice Address - Zip Code:88063-9175
Practice Address - Country:US
Practice Address - Phone:575-332-9393
Practice Address - Fax:575-332-9391
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-25
Last Update Date:2021-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy