Healthcare Provider Details

I. General information

NPI: 1184615510
Provider Name (Legal Business Name): JOHN SARGENT LANDRUM R.PH., M.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 11/03/2005
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1765 POMONA DR
LAS CRUCES NM
88011-4919
US

IV. Provider business mailing address

1765 POMONA DR
LAS CRUCES NM
88011-4919
US

V. Phone/Fax

Practice location:
  • Phone: 505-522-0675
  • Fax: 505-646-6428
Mailing address:
  • Phone: 505-522-0675
  • Fax: 505-646-6428

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number4051
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number4051
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: