Individual
MR. ALFRED VICTOR BACA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
REGISTERED PHARMACIS
Contact information
Practice address
1719 S AVENUE D, PORTALES, NM 88130-7241
(505) 356-8555
(505) 356-5659
Mailing address
1663 S ROOSEVELT ROAD 4, PORTALES, NM 88130-9678
(505) 356-8555
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
4514
NM
Other
Enumeration date
01/17/2007
Last updated
07/08/2007
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