Sierra Blanca Pharmacy LLC

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

PH00003414 Issued in NM

Legal business name

SIERRA BLANCA PHARMACY LLC

Doing business as

Sierra Blanca Pharmacy

Practice address

1206 Mechem Dr
Ruidoso, NM 88345-7206

Phone

(575) 258-2456

Fax

(575) 258-2465

NPI assigned

May 7, 2012

Last updated

Nov 21, 2013By 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

Chris WoodulNPI 1205020880

Title

RPH, Parmacist in Charge

Phone

(575) 258-2819

Specialties & licenses 4

Addresses

Other identifiers 1

Other names 1

• Sierra Blanca Pharmacy Doing business as

Medicare fee-for-service enrollment

Enrolled in NM

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 3

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.

• Chris H Woodul, RPH

  • Pharmacist
  • Ruidoso, NM
  • NPI 1205020880
  NPD Authorized official
• Courtney Ann Kessler, PHARMD

  • Pharmacist
  • Ruidoso, NM
  • NPI 1982175279
  NPD (past)
• Alexis Christianna Meliniotis, PHARMD

  • Pharmacist
  • Ruidoso, NM
  • NPI 1508520347
  NPD (past)

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

{
    "created_epoch": "1336348800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1384992000000",
    "number": "1740549054",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1206 MECHEM DR",
            "city": "RUIDOSO",
            "state": "NM",
            "postal_code": "883457206",
            "telephone_number": "575-258-2456",
            "fax_number": "575-258-2465"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1206 MECHEM DR",
            "city": "RUIDOSO",
            "state": "NM",
            "postal_code": "883457206",
            "telephone_number": "575-258-2456",
            "fax_number": "575-258-2465"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SIERRA BLANCA PHARMACY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-05-07",
        "last_updated": "2013-11-21",
        "status": "A",
        "authorized_official_last_name": "WOODUL",
        "authorized_official_first_name": "CHRIS",
        "authorized_official_title_or_position": "RPH, PARMACIST IN CHARGE",
        "authorized_official_telephone_number": "575-258-2819"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "NM",
            "license": "PH00003414",
            "primary": true
        },
        {
            "code": "3336C0004X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Compounding Pharmacy",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP PROVIDER IDENTIFICATION NUMBER",
            "identifier": "3212343",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Sierra Blanca Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Walter R Seidel, MD
• Kelli D Shaw, LADAC
• Shuttle Ruidoso, LLC
• Sierra Blanca Counseling
• Sierra Blanca Family Medicine PC
• Anjanette T Silva, M.A., CCC-SLP
• Abhinav Singh, MD
• Smarthealth Enterprise LLC (Riudoso walk-in clinic)
• Dennis Smith
• Melanie M Smith

• Community/Retail Pharmacy in Ruidoso, NM
• Providers in Ruidoso, 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 Nov 21, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.