Provider Demographics
NPI:1679312052
Name:HILLRISE PHARMACY DEMING LLC
Entity type:Organization
Organization Name:HILLRISE PHARMACY DEMING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RAJESH KUMAR
Authorized Official - Middle Name:
Authorized Official - Last Name:KANAKAVALLI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:917-855-1189
Mailing Address - Street 1:820 E FLORIDA ST
Mailing Address - Street 2:
Mailing Address - City:DEMING
Mailing Address - State:NM
Mailing Address - Zip Code:88030-5312
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:820 E FLORIDA ST
Practice Address - Street 2:
Practice Address - City:DEMING
Practice Address - State:NM
Practice Address - Zip Code:88030-5312
Practice Address - Country:US
Practice Address - Phone:917-855-1189
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-23
Last Update Date:2024-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy