Provider Demographics
NPI:1902358468
Name:SOUTHWEST HOME SOLUTIONS LLC
Entity Type:Organization
Organization Name:SOUTHWEST HOME SOLUTIONS LLC
Other - Org Name:ALBUQUERQUE CITY DRUG
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT OF PHARMACY
Authorized Official - Prefix:
Authorized Official - First Name:JUSTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:GRAVES
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:469-387-5661
Mailing Address - Street 1:205 SILVER AVE SW STE D
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87102
Mailing Address - Country:US
Mailing Address - Phone:505-705-3540
Mailing Address - Fax:505-247-0617
Practice Address - Street 1:205 SILVER AVE SW STE D
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87102-3593
Practice Address - Country:US
Practice Address - Phone:214-404-7787
Practice Address - Fax:214-943-1751
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-01
Last Update Date:2022-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2166032OtherPK