Provider Demographics
NPI:1851086557
Name:SOCORRO COMMUNITY PHARMACY
Entity Type:Organization
Organization Name:SOCORRO COMMUNITY PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHRISTINA
Authorized Official - Middle Name:R
Authorized Official - Last Name:ELSWICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:575-491-3255
Mailing Address - Street 1:PO BOX 433
Mailing Address - Street 2:
Mailing Address - City:SOCORRO
Mailing Address - State:NM
Mailing Address - Zip Code:87801-0433
Mailing Address - Country:US
Mailing Address - Phone:575-322-2117
Mailing Address - Fax:575-322-2454
Practice Address - Street 1:110 N CALIFORNIA ST
Practice Address - Street 2:
Practice Address - City:SOCORRO
Practice Address - State:NM
Practice Address - Zip Code:87801-4203
Practice Address - Country:US
Practice Address - Phone:575-322-2117
Practice Address - Fax:575-446-0073
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-07
Last Update Date:2023-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy