Organization
WELLBORN PHARMACY, INC
Active
Other names
Mesa Winds Healthmart Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
BRIAN WILSON (OWNER / PRESIDENT)
(575) 461-2784
Entity
Organization
Contact information
Practice address
1923 S 1ST ST, TUCUMCARI, NM 88401-3826
(575) 461-2784
(575) 461-2994
Mailing address
PO BOX 985, TUCUMCARI, NM 88401-0985
(575) 461-2784
(575) 461-2994
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PH00003107
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2122816
PK
—
05
—
56903
—
NM
Enumeration date
12/15/2006
Last updated
07/20/2022
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