Organization
OLIVE TREE PHARMACY, CO.
Active
Other names
Olive Tree Compounding Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
NDIDIAMAKA OKPAREKE PHARMD (PRESIDENT AND OWNER)
(706) 509-1012
Entity
Organization
Contact information
Practice address
1920 WESTSIDE BLVD SE STE B, RIO RANCHO, NM 87124-4893
(505) 738-3328
Mailing address
1920 WESTSIDE BLVD SE STE B, RIO RANCHO, NM 87124-4893
(505) 738-3328
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
PH00004369
NM
Other
Enumeration date
02/14/2017
Last updated
02/14/2017
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