Provider Demographics
NPI:1932400397
Name:PRESBYTERIAN HEALTHCARE SERVICES
Entity Type:Organization
Organization Name:PRESBYTERIAN HEALTHCARE SERVICES
Other - Org Name:PRESBYTERIAN SPECIALTY CARE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP, PHARMACY AND INFUSION SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:ERICA
Authorized Official - Middle Name:
Authorized Official - Last Name:DOWNING
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:505-724-8994
Mailing Address - Street 1:4580 PARADISE BLVD NW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87114-4105
Mailing Address - Country:US
Mailing Address - Phone:505-823-8800
Mailing Address - Fax:866-248-0801
Practice Address - Street 1:4580 PARADISE BLVD NW
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87114-4105
Practice Address - Country:US
Practice Address - Phone:505-823-8800
Practice Address - Fax:866-248-0801
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-16
Last Update Date:2023-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0003X, 3336M0002X
NMPH000032763336S0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336S0011XSuppliersPharmacySpecialty Pharmacy
No333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336M0002XSuppliersPharmacyMail Order Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2127585OtherPK