Organization
TAOS PHARMACY INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JAKE MOSSMAN RPH (PRESIDENT PIC)
(505) 758-3342
Entity
Organization
Contact information
Practice address
622 PASEO DEL PUEBLO SUR STE A, 5401 NDCBU, TAOS, NM 87571-5101
(505) 758-3342
(505) 785-2480
Mailing address
622 PASEO DEL PUEBLO SUR STE A, 5401 NDCBU, TAOS, NM 87571-5101
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PH00001826
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3207265
OTHER ID NUMBER
—
05
—
64097
—
NM
Enumeration date
06/24/2006
Last updated
09/13/2007
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