Provider Demographics
NPI:1912512088
Name:ZIA FAMILY HEALTH AND PHARMACY
Entity Type:Organization
Organization Name:ZIA FAMILY HEALTH AND PHARMACY
Other - Org Name:PHARMACY 575
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:ANDREW
Authorized Official - Last Name:POLING
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:405-401-1264
Mailing Address - Street 1:305 E SANGER ST STE 600
Mailing Address - Street 2:
Mailing Address - City:HOBBS
Mailing Address - State:NM
Mailing Address - Zip Code:88240-4405
Mailing Address - Country:US
Mailing Address - Phone:575-263-2908
Mailing Address - Fax:575-263-2909
Practice Address - Street 1:305 E SANGER ST STE 600
Practice Address - Street 2:
Practice Address - City:HOBBS
Practice Address - State:NM
Practice Address - Zip Code:88240-4405
Practice Address - Country:US
Practice Address - Phone:575-263-2908
Practice Address - Fax:575-263-2909
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-15
Last Update Date:2021-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM12339512Medicaid