Provider Demographics
NPI:1477062370
Name:LUCERO, VANESSA MONIQUE (PHARMD)
Entity Type:Individual
Prefix:
First Name:VANESSA
Middle Name:MONIQUE
Last Name:LUCERO
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:VANESSA
Other - Middle Name:MONIQUE
Other - Last Name:CONLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:14 VIA BELLA
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87507-8048
Mailing Address - Country:US
Mailing Address - Phone:505-929-3126
Mailing Address - Fax:
Practice Address - Street 1:1010 SPRUCE ST
Practice Address - Street 2:
Practice Address - City:ESPANOLA
Practice Address - State:NM
Practice Address - Zip Code:87532-2724
Practice Address - Country:US
Practice Address - Phone:505-367-0456
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-22
Last Update Date:2017-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMRP00007181183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist