Organization
COMPOUNDING SPECIALISTS OF THE SOUTHWEST, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SCOTT WAYNE WALLIS R.PH. (PRESIDENT)
(575) 524-2863
Entity
Organization
Contact information
Practice address
2140 N MAIN ST, LAS CRUCES, NM 88001-1129
(575) 524-2863
(575) 525-3192
Mailing address
2140 N MAIN ST, LAS CRUCES, NM 88001-1129
(575) 524-2863
(575) 525-3192
Taxonomy
Speciality
Code
Description
License number
State
3336C0004X
Compounding Pharmacy
Primary
PH00003193
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PH0003193
RETAIL PHARMACY
NM
Enumeration date
05/26/2010
Last updated
05/26/2010
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