Healthcare Provider Details

I. General information

NPI: 1093093403
Provider Name (Legal Business Name): JAMES A LUCERO RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/02/2011
Last Update Date: 08/02/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 TRAMWAY BLVD SE
ALBUQUERQUE NM
87123-3934
US

IV. Provider business mailing address

200 TRAMWAY BLVD SE
ALBUQUERQUE NM
87123-3934
US

V. Phone/Fax

Practice location:
  • Phone: 505-296-9751
  • Fax: 505-271-9095
Mailing address:
  • Phone: 505-296-9751
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number5355
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: