Portales Professional Compounding LLC

NPI #1679891238 in Portales, New Mexico

Provider Information

NPI Number
1679891238
Entity Type
Organization
Organization Name
Portales Professional Compounding LLC
Primary Specialty
Pharmacy - Compounding Pharmacy
Enumeration Date
May 6, 2010
Last Updated
May 6, 2010

Practice Location

Address
1719 S. AVE D
ZIP Code
88130
Phone
(575) 356-8433

Authorized Official

Name
MR. ALFRED VICTOR BACA
Title
PHARMACIST
Phone
(575) 356-6068

Specialties & Taxonomy Codes

Specialty
Pharmacy - Compounding PharmacyCompounding Pharmacy

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