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
- City
- Portales
- State
- New Mexico
- 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 Pharmacy — Compounding Pharmacy |
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