Organization
SIERRA BLANCA PHARMACY LLC
Active
Other names
Sierra Blanca Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
CHRIS WOODUL (RPH, PARMACIST IN CHARGE)
(575) 258-2819
Entity
Organization
Contact information
Practice address
1206 MECHEM DR, RUIDOSO, NM 88345-7206
(575) 258-2456
(575) 258-2465
Mailing address
1206 MECHEM DR, RUIDOSO, NM 88345-7206
(575) 258-2456
(575) 258-2465
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PH00003414
NM
3336C0004X
Compounding Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3212343
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
05/07/2012
Last updated
11/21/2013
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