Organization
QUINTANAS FAIRVIEW PHARMACY INC
Active
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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