Organization
QUINTANAS FAIRVIEW PHARMACY INC
Active
Other names
FAIRVIEW PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
LARRY QUINTANA RPH (PRESIDENT)
(505) 753-2209
Entity
Organization
Contact information
Practice address
734 N RIVERSIDE DR, STE A, ESPANOLA, NM 87532-2957
(505) 753-2209
(505) 753-8408
Mailing address
734 N RIVERSIDE DR, STE A, ESPANOLA, NM 87532-2957
(505) 753-2209
(505) 753-8408
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PH00001141
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2057691
PK
—
05
—
55731
—
NM
Enumeration date
01/16/2007
Last updated
10/29/2014
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