Healthcare Provider Details

I. General information

NPI: 1063386720
Provider Name (Legal Business Name): RUBEN EMILIO LUCERO PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2025
Last Update Date: 10/03/2025
Certification Date: 09/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 NEW MEXICO 528, SOUTH EAST
RIO RANCHO NM
87124
US

IV. Provider business mailing address

1001 NEW MEXICO 528, SOUTH EAST
RIO RANCHO NM
87124
US

V. Phone/Fax

Practice location:
  • Phone: 505-896-2078
  • Fax:
Mailing address:
  • Phone: 505-896-2078
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP00010389
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: