Healthcare Provider Details

I. General information

NPI: 1144173683
Provider Name (Legal Business Name): CAMERINO LOPEZ PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/16/2026
Last Update Date: 02/16/2026
Certification Date: 02/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

980 US HIGHWAY 491
GALLUP NM
87301-5339
US

IV. Provider business mailing address

980 US HIGHWAY 491
GALLUP NM
87301-5339
US

V. Phone/Fax

Practice location:
  • Phone: 505-722-9977
  • Fax: 505-722-8481
Mailing address:
  • Phone: 505-722-9977
  • Fax: 505-722-8481

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP00010445
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: