Provider Demographics
NPI:1982824876
Name:NEW MEXICO DEPARTMENT OF HEALTH PHARMACY
Entity Type:Organization
Organization Name:NEW MEXICO DEPARTMENT OF HEALTH PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST ADVANCED
Authorized Official - Prefix:MRS
Authorized Official - First Name:SONYA
Authorized Official - Middle Name:REYNE
Authorized Official - Last Name:MIERA
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:505-476-8354
Mailing Address - Street 1:1301 SILER RD
Mailing Address - Street 2:BUILDING A
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87507-3541
Mailing Address - Country:US
Mailing Address - Phone:505-476-8358
Mailing Address - Fax:505-424-3438
Practice Address - Street 1:1301 SILER RD
Practice Address - Street 2:BUILDING A
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87507-3541
Practice Address - Country:US
Practice Address - Phone:505-476-8358
Practice Address - Fax:505-424-3438
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-26
Last Update Date:2009-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMPH000016083336C0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0002XSuppliersPharmacyClinic Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM3209954OtherNCPDP