MEDICARE: ELAINE M LUCERO B.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	4390	NM

General Provider Information

NPI Number	:	1518188937
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELAINE M LUCERO B.S.

Provider Business Mailing Address
First Line	:	1501 ALFREDO GARCIA CT NW
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87107-7109
Country	:	US
Telephone Number	:	505-344-7999
Fax Number	:

Provider Business Practice Location Address
First Line	:	2620 CARLISLE BLVD NE
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87110-2802
Country	:	US
Telephone Number	:	505-884-0455
Fax Number	:	505-872-1842

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/01/2007
Last Update Date	:	07/08/2007

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Directions to “ ELAINE M LUCERO B.S.” Practice Location

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