Provider Demographics
NPI:1871011031
Name:SOCORRO FAMILY PHARMACY
Entity Type:Organization
Organization Name:SOCORRO FAMILY PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TAIWO
Authorized Official - Middle Name:
Authorized Official - Last Name:OKUNADE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:915-857-5510
Mailing Address - Street 1:12371 EDGEMERE BLVD STE 210
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79938-4879
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:10680 N LOOP DR STE AB
Practice Address - Street 2:
Practice Address - City:SOCORRO
Practice Address - State:TX
Practice Address - Zip Code:79927-4613
Practice Address - Country:US
Practice Address - Phone:915-857-5510
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-07
Last Update Date:2017-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy