Organization
GUADALUPE COUNTY
Active
Organization
GUADALUPE COUNTY
Active
Other names
Route 66 Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
CHRISTINA CAMPOS MBA (ADMINISTRATOR)
(575) 472-5666
Entity
Organization
Contact information
Practice address
117 CAMINO DE VIDA STE 200, SANTA ROSA, NM 88435-2267
(575) 472-5666
(575) 472-9666
Mailing address
117 CAMINO DE VIDA STE 200, SANTA ROSA, NM 88435-2267
(575) 472-5666
(575) 472-9666
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PH00003554
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2141912
PK
—
05
—
88484009
—
NM
Enumeration date
02/21/2007
Last updated
09/12/2023
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