Organization
AOM PHARMACY ADVANCED ORTHOMOLECULAR MEDICINE
Active
Other names
AOM Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
JAMES MARCILLA (OWNER/PHARMACIST IN CHARGE)
(505) 280-5078
Entity
Organization
Contact information
Practice address
4514 CENTRAL AVE SE, SE, ALBUQUERQUE, NM 87108-1212
(505) 266-2022
(505) 266-2882
Mailing address
4514 CENTRAL AVE SE, ALBUQUERQUE, NM 87108-1212
(505) 266-2022
(505) 266-2882
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PH00003344
NM
3336C0004X
Compounding Pharmacy
—
—
3336S0011X
Specialty Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3212242
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
12/18/2011
Last updated
02/10/2012
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