Provider Demographics
NPI:1407986680
Name:EUGENE L GUTIERREZ
Entity Type:Organization
Organization Name:EUGENE L GUTIERREZ
Other - Org Name:TRUST PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:RPH PHARMACIST
Authorized Official - Prefix:MR
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:R
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:505-287-3913
Mailing Address - Street 1:1000 E ROOSEVELT AVE
Mailing Address - Street 2:
Mailing Address - City:GRANTS
Mailing Address - State:NM
Mailing Address - Zip Code:87020-2118
Mailing Address - Country:US
Mailing Address - Phone:505-287-3913
Mailing Address - Fax:505-287-4379
Practice Address - Street 1:1000 E ROOSEVELT AVE
Practice Address - Street 2:
Practice Address - City:GRANTS
Practice Address - State:NM
Practice Address - Zip Code:87020-2118
Practice Address - Country:US
Practice Address - Phone:505-287-3913
Practice Address - Fax:505-287-4379
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-06
Last Update Date:2010-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMPH00001734333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM3204219OtherNAPB