Provider Demographics
NPI:1013338847
Name:FARMER'S UPTOWN PHARMACY, LLC
Entity Type:Organization
Organization Name:FARMER'S UPTOWN PHARMACY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:NEAL
Authorized Official - Middle Name:CLIFFORD
Authorized Official - Last Name:DUNGAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:575-885-4002
Mailing Address - Street 1:2402 W PIERCE ST
Mailing Address - Street 2:2B
Mailing Address - City:CARLSBAD
Mailing Address - State:NM
Mailing Address - Zip Code:88220-3537
Mailing Address - Country:US
Mailing Address - Phone:575-885-4002
Mailing Address - Fax:
Practice Address - Street 1:2800 N MAIN ST
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:NM
Practice Address - Zip Code:88201-6500
Practice Address - Country:US
Practice Address - Phone:575-885-4002
Practice Address - Fax:575-885-5714
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-20
Last Update Date:2013-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy