Organization
PORTALES PROFESSIONAL COMPOUNDING LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ALFRED VICTOR BACA (PHARMACIST)
(575) 356-6068
Entity
Organization
Contact information
Practice address
1719 S. AVE D, PORTALES, NM 88130
(575) 356-8433
Mailing address
1719 S. AVE D, PORTALES, NM 88130
(575) 356-8433
Taxonomy
Speciality
Code
Description
License number
State
3336C0004X
Compounding Pharmacy
Primary
PH00002491
NM
Other
Enumeration date
05/06/2010
Last updated
05/06/2010
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