Provider Demographics
NPI:1215233820
Name:SW MESA CENTER FOR FAMILY AND COMMUNITY HEALTH PHARMACY
Entity type:Organization
Organization Name:SW MESA CENTER FOR FAMILY AND COMMUNITY HEALTH PHARMACY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF PHARMACY
Authorized Official - Prefix:
Authorized Official - First Name:FRIEDA
Authorized Official - Middle Name:
Authorized Official - Last Name:ORTEGA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-272-0526
Mailing Address - Street 1:301 UNSER BLVD NW
Mailing Address - Street 2:STE 106
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87121-1927
Mailing Address - Country:US
Mailing Address - Phone:505-925-4451
Mailing Address - Fax:505-925-4192
Practice Address - Street 1:301 UNSER BLVD NW STE 106
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87121-1927
Practice Address - Country:US
Practice Address - Phone:505-925-4451
Practice Address - Fax:505-925-4192
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-28
Last Update Date:2014-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
NMPH000032403336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
3212103OtherNCPDP PROVIDER IDENTIFICATION NUMBER