Provider Demographics
NPI:1376421966
Name:DAVID M LANSFORD, PC
Entity type:Organization
Organization Name:DAVID M LANSFORD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / PHARMACIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MICAH
Authorized Official - Middle Name:ANDREW
Authorized Official - Last Name:LANSFORD
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD, RPH
Authorized Official - Phone:575-762-3848
Mailing Address - Street 1:305 E LLANO ESTACADO BLVD
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:NM
Mailing Address - Zip Code:88101-3778
Mailing Address - Country:US
Mailing Address - Phone:575-762-3848
Mailing Address - Fax:575-762-3848
Practice Address - Street 1:305 E LLANO ESTACADO BLVD
Practice Address - Street 2:
Practice Address - City:CLOVIS
Practice Address - State:NM
Practice Address - Zip Code:88101-3778
Practice Address - Country:US
Practice Address - Phone:575-762-3848
Practice Address - Fax:575-762-3848
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-08-22
Last Update Date:2025-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM57133Medicaid