# STATE OF NEW MEXICO

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- **Entity:** Organization
- **Status:** Active
- **Other names:** New Mexico State Veterans Pharmacy
- **Organization subpart:** No

## Provider details

- **NPI number:** 1033135074
- **Authorized official:** MARIE R RICHTER (ADMINISTRATIVE SERVICES DIRECTOR)
- **Authorized official phone:** (575) 894-4216

## Contact information

- **Practice address:** 992 S BROADWAY, TRUTH OR CONSEQUENCES, NM 87901
- **Practice address phone:** (575) 894-4200
- **Practice address fax:** (575) 894-4291
- **Mailing address:** 992 S BROADWAY, TRUTH OR CONSEQUENCES, NM 87901
- **Mailing address phone:** (575) 894-4200
- **Mailing address fax:** (575) 894-4291

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 183500000X | Pharmacist | CS00021264 | NM | Yes |

## Other

- **Enumeration date:** 07/14/2006
- **Last updated:** 04/18/2017

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 3208774 | MEDICARE D | NM |
| 05 | — | 65755 | — | NM |