Provider Demographics
NPI:1093956732
Name:TRUJILLO, THEODORE A (RPH)
Entity Type:Individual
Prefix:MR
First Name:THEODORE
Middle Name:A
Last Name:TRUJILLO
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 1:2551 E LOHMAN AVE
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88011-8233
Mailing Address - Country:US
Mailing Address - Phone:575-521-9841
Mailing Address - Fax:575-521-5907
Practice Address - Street 1:2551 E LOHMAN
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88011-8233
Practice Address - Country:US
Practice Address - Phone:575-521-9841
Practice Address - Fax:575-521-5907
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-10
Last Update Date:2009-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM6053183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist