Organization
JERRY P ARCHULETA SANLUIS PHARMACY LLC
Active
Other names
SAN LUIS VALLEY PHARMACY LLC
Organization subpart
No
Provider details
NPI number
Authorized official
JERRY ARCHULEKA (OWNER)
(719) 587-3039
Entity
Organization
Contact information
Practice address
2431 MAIN ST, STE 5, ALAMOSA, CO 81101-4273
(719) 587-3039
(719) 587-2164
Mailing address
2431 MAIN ST, STE 5, ALAMOSA, CO 81101-4273
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
Primary
PDO20000022
CO
3336C0003X
Community/Retail Pharmacy
—
—
3336M0002X
Mail Order Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0618326
OTHER ID NUMBER-COMMERCIAL NUMBER
—
Enumeration date
11/17/2006
Last updated
02/06/2008
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