Portales Professional Compounding LLC

Primary specialty

Compounding PharmacyTaxonomy code 3336C0004X

License

PH00002491 Issued in NM

Legal business name

PORTALES PROFESSIONAL COMPOUNDING LLC

Practice address

1719 S. Ave D
Portales, NM 88130

Phone

(575) 356-8433

NPI assigned

May 6, 2010

Last updated

May 6, 2010By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Alfred Victor BacaNPI 1912059304

Title

Pharmacist

Phone

(575) 356-6068

Specialties & licenses 1

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Alfred Victor Baca, REGISTERED PHARMACIS

  • Pharmacist
  • Portales, NM
  • NPI 1912059304
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1273104000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1273104000000",
    "number": "1679891238",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1719 S. AVE D",
            "city": "PORTALES",
            "state": "NM",
            "postal_code": "88130",
            "telephone_number": "575-356-8433"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1719 S. AVE D",
            "city": "PORTALES",
            "state": "NM",
            "postal_code": "88130",
            "telephone_number": "575-356-8433"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PORTALES PROFESSIONAL COMPOUNDING LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-05-06",
        "last_updated": "2010-05-06",
        "status": "A",
        "authorized_official_last_name": "BACA",
        "authorized_official_first_name": "ALFRED",
        "authorized_official_middle_name": "VICTOR",
        "authorized_official_title_or_position": "PHARMACIST",
        "authorized_official_telephone_number": "575-356-6068",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "3336C0004X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Compounding Pharmacy",
            "state": "NM",
            "license": "PH00002491",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Portales Dental Arts Center Inc
• Portales Health Facilities LP (Loma Linda Nursing and Rehabilitation Center)
• Portales Home Medical Equipment Inc
• Portales Medical Clinic Limited
• Portales Municipal Schools
• William Porter
• Professional Dental Care of Southern Colorado I PLLC (Thompson Smiles)
• Professional Dental Care of Southern NM I PLLC (Peter Thompson, DDS)
• Frances Ann Rains, COTA
• Alyssa Ramirez

• Compounding Pharmacy in Portales, NM
• Providers in Portales, NM by specialty
• Compounding Pharmacy in New Mexico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 6, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.