Healthcare Provider Details

I. General information

NPI: 1437591633
Provider Name (Legal Business Name): TRAPPER ELDRIDGE PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2013
Last Update Date: 07/29/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 E. LLANO ESTACADO BLVD
CLOVIS NM
88101
US

IV. Provider business mailing address

601 E. LLANO ESTACADO BLVD
CLOVIS NM
88101
US

V. Phone/Fax

Practice location:
  • Phone: 575-762-3848
  • Fax: 575-762-3840
Mailing address:
  • Phone: 575-762-3848
  • Fax: 575-762-3840

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number7216
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: