Healthcare Provider Details

I. General information

NPI: 1780917971
Provider Name (Legal Business Name): MIRIAM LUCERO PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/07/2009
Last Update Date: 10/17/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1625 RIO BRAVO BLVD SW SUITE 36
ALBUQUERQUE NM
87105-6057
US

IV. Provider business mailing address

3401 ISLETA BLVD SW
ALBUQUERQUE NM
87105-5836
US

V. Phone/Fax

Practice location:
  • Phone: 505-877-3130
  • Fax: 505-877-8072
Mailing address:
  • Phone: 505-877-3130
  • Fax: 505-877-8072

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP00006451
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: