Organization
SIERRA BLANCA PHARMACY LLC
Active
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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