Organization
VIDA PHARMACY LLC
Active
Other names
VIDA PHARMACY LLC
Organization subpart
No
Provider details
NPI number
Authorized official
ANNABEL ROBERTS PHARMD (OWNER)
(505) 856-1660
Entity
Organization
Contact information
Practice address
8500 JEFFERSON ST NE, STE D, ALBUQUERQUE, NM 87113-1883
(505) 856-1660
(505) 856-7141
Mailing address
8500 JEFFERSON ST NE, STE D, ALBUQUERQUE, NM 87113-1883
(505) 856-1660
(505) 856-7141
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336L0003X
Long Term Care Pharmacy
Primary
PH00002980
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2059025
PK
—
Enumeration date
11/14/2007
Last updated
12/03/2020
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