Healthcare Provider Details

I. General information

NPI: 1316606031
Provider Name (Legal Business Name): LANCE TRUJILLO PHARM.D., BCPS, PHC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/09/2021
Last Update Date: 10/30/2025
Certification Date: 10/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

530 N TELSHOR BLVD STE C
LAS CRUCES NM
88011-8243
US

IV. Provider business mailing address

298 WALL AVE
LAS CRUCES NM
88001-7609
US

V. Phone/Fax

Practice location:
  • Phone: 575-215-3389
  • Fax:
Mailing address:
  • Phone: 575-636-7787
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License NumberPC00000534
License Number StateNM
# 3
Primary TaxonomyN
Taxonomy Code1835E0208X
TaxonomyEmergency Medicine Pharmacist
License NumberRP00008393
License Number StateNM
# 4
Primary TaxonomyN
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License NumberRP00008393
License Number StateNM
# 5
Primary TaxonomyN
Taxonomy Code261QM2800X
TaxonomyMethadone Clinic
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: