Organization
NOWELL PHARMACY LLC
Active
Other names
NOWELL PHARMACY, LLC
Organization subpart
No
Provider details
NPI number
Authorized official
JENNA DOMZALSKI DE RIOS PHARMACY (OWNER)
(575) 396-6746
Entity
Organization
Contact information
Practice address
122 W ADAMS AVE, LOVINGTON, NM 88260-4010
(575) 396-4242
(575) 396-3133
Mailing address
122 W ADAMS AVE, LOVINGTON, NM 88260-4010
(575) 396-4242
(575) 396-3133
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PH00001233
NM
3336L0003X
Long Term Care Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2056596
PK
—
05
—
56630
—
NM
Enumeration date
08/10/2006
Last updated
09/18/2017
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