Healthcare Provider Details

I. General information

NPI: 1174756498
Provider Name (Legal Business Name): ALBERT JAMES LUNA RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/02/2009
Last Update Date: 02/17/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2101 NORTHERN BLVD NE
RIO RANCHO NM
87124-4727
US

IV. Provider business mailing address

2101 NORTHERN BLVD NE
RIO RANCHO NM
87124-4727
US

V. Phone/Fax

Practice location:
  • Phone: 505-217-3980
  • Fax: 505-217-3986
Mailing address:
  • Phone: 505-217-3980
  • Fax: 505-217-3986

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP00006148
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: