Provider Demographics
NPI:1356364343
Name:MAY PHARMACY CEDAR CREST INC
Entity type:Organization
Organization Name:MAY PHARMACY CEDAR CREST INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT / OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CONNIE
Authorized Official - Middle Name:
Authorized Official - Last Name:TSUI
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:505-828-2348
Mailing Address - Street 1:12129 HWY 14 N
Mailing Address - Street 2:
Mailing Address - City:CEDAR CREST
Mailing Address - State:NM
Mailing Address - Zip Code:87008-9492
Mailing Address - Country:US
Mailing Address - Phone:505-281-6488
Mailing Address - Fax:505-281-6484
Practice Address - Street 1:12129 HWY 14 N
Practice Address - Street 2:
Practice Address - City:CEDAR CREST
Practice Address - State:NM
Practice Address - Zip Code:87008-9492
Practice Address - Country:US
Practice Address - Phone:505-281-6488
Practice Address - Fax:505-281-6484
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-25
Last Update Date:2011-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3336L0003X, 3336C0003X
NMPH00003103333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
3211226OtherNCPDP PROVIDER IDENTIFICATION NUMBER
NM55956033Medicaid
NM55956033Medicaid