Healthcare Provider Details

I. General information

NPI: 1598073074
Provider Name (Legal Business Name): ROBERT A LUCERO RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/19/2010
Last Update Date: 09/19/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 N GUADALUPE ST
SANTA FE NM
87501-1456
US

IV. Provider business mailing address

600 N GUADALUPE ST
SANTA FE NM
87501-1456
US

V. Phone/Fax

Practice location:
  • Phone: 505-982-4806
  • Fax: 505-982-5138
Mailing address:
  • Phone: 505-982-4806
  • Fax: 505-982-5138

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP00005164
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: