Organization
FT BAYARD MEDICAL CENTER DEPARTMENT OF HEALTH
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JON MARK BAILEY RPH (DIRECTOR OF PHARMACY)
(575) 537-8745
Entity
Organization
Contact information
Practice address
41 FT. BAYARD RD., SANTA CLARA, NM 88026
(575) 537-8745
(575) 537-8897
Mailing address
PO BOX 293, SANTA CLARA, NM 88026-0293
(575) 537-8745
(575) 537-8897
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
3336L0003X
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
13343
IOWA BOARD OF PHARMACY LICENSE
IA
01
—
RP00006632
NEW BOARD OF PHARMACY PHARMACIST
NM
01
—
S005219
ARIZONA BOARD OF PHARMACY
AZ
Enumeration date
03/14/2016
Last updated
03/14/2016
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