Provider Demographics
NPI:1982849030
Name:UNIVERSITY OF NEW MEXICO HOSPITAL
Entity Type:Organization
Organization Name:UNIVERSITY OF NEW MEXICO HOSPITAL
Other - Org Name:UNMH PHARMACY AT SOUTH EAST HEIGHTS CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST INCHARGE
Authorized Official - Prefix:
Authorized Official - First Name:FRIEDA
Authorized Official - Middle Name:
Authorized Official - Last Name:ORTEGA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-272-0526
Mailing Address - Street 1:8200 CENTRAL AVE SE
Mailing Address - Street 2:SUITE 106
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87108-2408
Mailing Address - Country:US
Mailing Address - Phone:505-272-4563
Mailing Address - Fax:505-272-6885
Practice Address - Street 1:8200 CENTRAL AVE SE
Practice Address - Street 2:SUITE 106
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87108-2408
Practice Address - Country:US
Practice Address - Phone:505-272-4563
Practice Address - Fax:505-272-6885
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-03
Last Update Date:2012-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0002X, 3336I0012X
NMPH000030763336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336C0002XSuppliersPharmacyClinic Pharmacy
No3336I0012XSuppliersPharmacyInstitutional Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
3211771OtherNCPDP PROVIDER IDENTIFICATION NUMBER