Organization
TW WELLNESS
Active
Other names
TW Wellness
Organization subpart
No
Provider details
NPI number
Authorized official
BENJAMIN WHITE (OWNER)
(505) 717-2342
Entity
Organization
Contact information
Practice address
8225 4TH ST NW, LOS RANCHOS, NM 87114-1014
(505) 717-2342
(505) 492-2549
Mailing address
8225 4TH ST NW, LOS RANCHOS, NM 87114-1014
(505) 717-2342
(505) 492-2549
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0004X
Compounding Pharmacy
Primary
CS00222956
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2159758
PK
—
Enumeration date
05/02/2016
Last updated
05/02/2016
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