Provider Demographics
NPI:1528445053
Name:UNIVERSITY OF NM HOSPITAL RETAIL PHARMACY
Entity type:Organization
Organization Name:UNIVERSITY OF NM HOSPITAL RETAIL PHARMACY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF PHARMACY OPERATION
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:LONG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-272-2035
Mailing Address - Street 1:2211 LOMAS BLVD NE
Mailing Address - Street 2:ATTN: INPATIENT PHARMACY
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87106-2719
Mailing Address - Country:US
Mailing Address - Phone:505-272-2035
Mailing Address - Fax:505-272-2037
Practice Address - Street 1:2211 LOMAS BLVD NE
Practice Address - Street 2:ATTN: INPATIENT PHARMACY
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87106-2719
Practice Address - Country:US
Practice Address - Phone:505-272-2035
Practice Address - Fax:505-272-2037
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-05
Last Update Date:2015-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMPH000032953336I0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336I0012XSuppliersPharmacyInstitutional Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2151529OtherPK