Provider Demographics
NPI:1881202372
Name:MODERN ALCHEMIST COMPOUNDING PHARMACY
Entity Type:Organization
Organization Name:MODERN ALCHEMIST COMPOUNDING PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF PHARMACIST
Authorized Official - Prefix:DR
Authorized Official - First Name:NAWID
Authorized Official - Middle Name:
Authorized Official - Last Name:FARHAD
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:505-200-0033
Mailing Address - Street 1:PO BOX 93603
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87199-3603
Mailing Address - Country:US
Mailing Address - Phone:505-200-0033
Mailing Address - Fax:505-916-0063
Practice Address - Street 1:7900 SAN PEDRO DR NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-4672
Practice Address - Country:US
Practice Address - Phone:505-200-0033
Practice Address - Fax:505-916-0063
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-21
Last Update Date:2020-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy