# JERRY P ARCHULETA SANLUIS PHARMACY LLC

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Other names:** SAN LUIS VALLEY PHARMACY LLC
- **Organization subpart:** No

## Provider details

- **NPI number:** 1437223955
- **Authorized official:** JERRY ARCHULEKA (OWNER)
- **Authorized official phone:** (719) 587-3039

## Contact information

- **Practice address:** 2431 MAIN ST, STE 5, ALAMOSA, CO 81101-4273
- **Practice address phone:** (719) 587-3039
- **Practice address fax:** (719) 587-2164
- **Mailing address:** 2431 MAIN ST, STE 5, ALAMOSA, CO 81101-4273

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 332B00000X | Durable Medical Equipment & Medical Supplies | — | — | — |
| 333600000X | Pharmacy | PDO20000022 | CO | Yes |
| 3336C0003X | Community/Retail Pharmacy | — | — | — |
| 3336M0002X | Mail Order Pharmacy | — | — | — |

## Other

- **Enumeration date:** 11/17/2006
- **Last updated:** 02/06/2008

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 0618326 | OTHER ID NUMBER-COMMERCIAL NUMBER | — |