Provider Demographics
NPI:1750803466
Name:BOBS' BUDGET PHARMACY
Entity type:Organization
Organization Name:BOBS' BUDGET PHARMACY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BOB
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCLELLAND
Authorized Official - Suffix:III
Authorized Official - Credentials:RPH
Authorized Official - Phone:575-461-1200
Mailing Address - Street 1:PO BOX 1266
Mailing Address - Street 2:
Mailing Address - City:TUCUMCARI
Mailing Address - State:NM
Mailing Address - Zip Code:88401-1266
Mailing Address - Country:US
Mailing Address - Phone:575-461-1200
Mailing Address - Fax:575-461-4189
Practice Address - Street 1:511 S 2ND ST
Practice Address - Street 2:
Practice Address - City:TUCUMCARI
Practice Address - State:NM
Practice Address - Zip Code:88401-2861
Practice Address - Country:US
Practice Address - Phone:575-461-1200
Practice Address - Fax:575-461-4189
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-13
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMPH2392333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy