Healthcare Provider Details

I. General information

NPI: 1346455680
Provider Name (Legal Business Name): DAVID M LANSFORD, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2007
Last Update Date: 09/22/2021
Certification Date: 09/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

305 E LLANO ESTACADO BLVD
CLOVIS NM
88101-3778
US

IV. Provider business mailing address

305 E LLANO ESTACADO BLVD
CLOVIS NM
88101-3778
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 Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number1846
License Number StateNM

VIII. Authorized Official

Name: DR. MICAH ANDREW LANSFORD
Title or Position: OWNER/PIC
Credential: PHARM.D., RPH
Phone: 575-762-3848