Provider Demographics
NPI:1093093403
Name:LUCERO, JAMES A (RPH)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:A
Last Name:LUCERO
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 TRAMWAY BLVD SE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87123-3934
Mailing Address - Country:US
Mailing Address - Phone:505-296-9751
Mailing Address - Fax:
Practice Address - Street 1:200 TRAMWAY BLVD SE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87123-3934
Practice Address - Country:US
Practice Address - Phone:505-296-9751
Practice Address - Fax:505-271-9095
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-02
Last Update Date:2011-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM53551835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist