Provider Demographics
NPI:1023147774
Name:WEST MESA REGENT PHARMACY
Entity type:Organization
Organization Name:WEST MESA REGENT PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER AND CHIEF PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:TSAY
Authorized Official - Middle Name:
Authorized Official - Last Name:ABDELHAD
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:505-831-0833
Mailing Address - Street 1:5300 SEQUOIA RD NW
Mailing Address - Street 2:SUITE L
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87120-1284
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5300 SEQUOIA RD NW
Practice Address - Street 2:SUITE L
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87120-1284
Practice Address - Country:US
Practice Address - Phone:505-831-0833
Practice Address - Fax:505-831-3269
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMPH00002238333600000X
3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered333600000XSuppliersPharmacy
Not Answered3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
3208104OtherOTHER ID NUMBER-COMMERCIAL NUMBER
NM066100Medicaid