# ADDISON DRUG

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1841219128
- **Authorized official:** MR. ROBERT M ADDISON RPH (OWNER)
- **Authorized official phone:** (505) 355-2211

## Contact information

- **Practice address:** 323 SUMNER AVE, FORT SUMNER, NM 88119-0550
- **Practice address phone:** (505) 355-2211
- **Practice address fax:** (505) 355-7816
- **Mailing address:** PO BOX 550, 127 E. SUMNER AVENUE, FORT SUMNER, NM 88119-0550
- **Mailing address phone:** (505) 355-2211
- **Mailing address fax:** (505) 355-7816

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 183500000X | Pharmacist | PH00001147 | NM | Yes |

## Other

- **Enumeration date:** 07/18/2006
- **Last updated:** 08/22/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 3202253 | NCPDP NUMBER | NM |
| 05 | — | 56390 | — | NM |