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Organization
ACOMA CANONCITO LAGUNA PHARMACY
Active
Organization
ACOMA CANONCITO LAGUNA PHARMACY
Active
Other names
ACL PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
INNA VOINICH PHARMD (CHIEF PHARMACIST)
(505) 552-5393
Entity
Organization
Contact information
Practice address
80 B VETERANS BLVD, ACOMA, NM 87034-8703
(505) 552-5393
(505) 552-5484
Mailing address
PO BOX 95475, CLEVELAND, OH 44101-0033
(505) 552-5394
(505) 552-5464
Taxonomy
Speciality
Code
Description
License number
State
332800000X
Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy
Primary
—
—
3336C0002X
Clinic Pharmacy
—
—
3336I0012X
Institutional Pharmacy
—
—
3336S0011X
Specialty Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3209245
NCPDP PROVIDER IDENTIFICATION NUMBER
—
05
—
H3451
—
NM
Enumeration date
03/13/2007
Last updated
02/10/2025
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