Organization
THOREAU HEALTH STATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
STACY WILLIAMS (CHIEF PHARMACIST)
(505) 786-6344
Entity
Organization
Contact information
Practice address
HWY 371 ROUTE 9, CROWNPOINT, NM 87313-0358
(505) 786-6344
(505) 786-6440
Mailing address
PO BOX 358, CROWNPOINT, NM 87313-0358
(505) 786-6344
(505) 786-6440
Taxonomy
Speciality
Code
Description
License number
State
3336C0002X
Clinic Pharmacy
Primary
AU4720846
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
021189
—
AZ
05
—
47209
—
NM
Enumeration date
04/13/2007
Last updated
08/22/2020
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