Provider Demographics
NPI:1700811007
Name:EL PASEO PHARMACY, LLC
Entity Type:Organization
Organization Name:EL PASEO PHARMACY, LLC
Other - Org Name:EL PASEO PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:FRANCIS
Authorized Official - Last Name:ADAMS
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:505-541-1500
Mailing Address - Street 1:1605 EL PASEO RD
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88001-6013
Mailing Address - Country:US
Mailing Address - Phone:505-541-1500
Mailing Address - Fax:505-541-5929
Practice Address - Street 1:1605 EL PASEO RD
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88001-6013
Practice Address - Country:US
Practice Address - Phone:505-541-1500
Practice Address - Fax:505-541-5929
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMPH-28123336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM27226565Medicaid