Organization
WAGREENS PHARMACY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DEREK TWITCHELL (REGISTERED PHARMACIST)
(505) 820-2196
Entity
Organization
Contact information
Practice address
525 W ZIA RD, SANTA FE, NM 87505-6910
(505) 820-2196
Mailing address
525 W ZIA RD, SANTA FE, NM 87505-6910
Taxonomy
Speciality
Code
Description
License number
State
302R00000X
Health Maintenance Organization
Primary
RP00007845
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
RP00007845
NEW MEXICO BOARD OF PHARMACY
NM
Enumeration date
08/07/2012
Last updated
08/07/2012
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