Organization
STATE OF NEW MEXICO
Active
Other names
NEW MEXICO BEHAVIORAL HEALTH INSTITUE AT LAS VEGAS
Organization subpart
No
Provider details
NPI number
Authorized official
DAN SMITH RPH (PHARMACY DIRECTOR)
(505) 454-2183
Entity
Organization
Contact information
Practice address
3695 HOT SPRINGS BLVD, LAS VEGAS, NM 87701-9549
(505) 454-2183
(505) 454-2182
Mailing address
3695 HOT SPRINGS BLVD, LAS VEGAS, NM 87701-9549
(505) 454-2183
(505) 454-2182
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336I0012X
Institutional Pharmacy
Primary
PH00002105
NM
3336L0003X
Long Term Care Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2056964
PK
—
05
—
61788
—
NM
Enumeration date
05/29/2007
Last updated
10/04/2016
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