Organization
JOE'S PHARMACY L.L.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MICHAEL LEON OTERO (MANAGING MEMBER/OWNER)
(505) 869-3646
Entity
Organization
Contact information
Practice address
3646 HIGHWAY 47, PERALTA, NM 87042-8468
(505) 869-3646
(505) 869-2070
Mailing address
3646 HIGHWAY 47, PERALTA, NM 87042-8468
(505) 869-3646
(505) 869-2070
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
2411
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
71907564
—
NM
05
—
96079355
—
NM
Enumeration date
05/25/2006
Last updated
08/22/2020
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