Provider Demographics
NPI:1093310955
Name:LUCERO, NERY R (PHARMACIST)
Entity Type:Individual
Prefix:
First Name:NERY
Middle Name:R
Last Name:LUCERO
Suffix:
Gender:F
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 CHESTNUT RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:MONTVALE
Mailing Address - State:NJ
Mailing Address - Zip Code:07645-1706
Mailing Address - Country:US
Mailing Address - Phone:201-505-4905
Mailing Address - Fax:201-505-4919
Practice Address - Street 1:106 CHESTNUT RIDGE RD
Practice Address - Street 2:
Practice Address - City:MONTVALE
Practice Address - State:NJ
Practice Address - Zip Code:07645-1706
Practice Address - Country:US
Practice Address - Phone:201-505-4905
Practice Address - Fax:201-505-4919
Is Sole Proprietor?:No
Enumeration Date:2020-11-30
Last Update Date:2020-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI02880600183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist