Wellborn Pharmacy, Inc

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

PH00003107 Issued in NM

Legal business name

WELLBORN PHARMACY, INC

Doing business as

Mesa Winds Healthmart Pharmacy

Practice address

1923 S 1St St
Tucumcari, NM 88401-3826

Phone

(575) 461-2784

Fax

(575) 461-2994

NPI assigned

Dec 15, 2006

Last updated

Jul 20, 2022By 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

Brian Wilson

Title

Owner / President

Phone

(575) 461-2784

Specialties & licenses 2

Addresses

Other identifiers 2

Other names 1

• Mesa Winds Healthmart Pharmacy Doing business as

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.

• Carlos G Marquez

  • Pharmacist
  • Tucumcari, NM
  • NPI 1023741246
  NPD (past)

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

{
    "created_epoch": "1166140800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658275200000",
    "number": "1720140569",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 985",
            "city": "TUCUMCARI",
            "state": "NM",
            "postal_code": "884010985",
            "telephone_number": "575-461-2784",
            "fax_number": "575-461-2994"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1923 S 1ST ST",
            "city": "TUCUMCARI",
            "state": "NM",
            "postal_code": "884013826",
            "telephone_number": "575-461-2784",
            "fax_number": "575-461-2994"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WELLBORN PHARMACY, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-15",
        "last_updated": "2022-07-20",
        "certification_date": "2022-07-20",
        "status": "A",
        "authorized_official_last_name": "WILSON",
        "authorized_official_first_name": "BRIAN",
        "authorized_official_title_or_position": "OWNER / PRESIDENT",
        "authorized_official_telephone_number": "575-461-2784"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "NM",
            "license": "PH00003107",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2122816",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "56903",
            "state": "NM"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mesa Winds Healthmart Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Frank A Velazquez, CRNA
• Jina Vick, CNP
• Hannah Brooke Walker, M.S. CCC-SLP
• Lynette Walker, BMS
• Haily Wallace, MD
• Becky Whitson
• Jamie Williams
• Lloyd Lee Williams, FNP-C
• Darrell E Willis, MD
• Irma O Zacarias

• Community/Retail Pharmacy in Tucumcari, NM
• Providers in Tucumcari, NM by specialty
• Community/Retail Pharmacy in New Mexico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 20, 2022; 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.