Provider Demographics
NPI:1518188937
Name:LUCERO, ELAINE M (BS)
Entity Type:Individual
Prefix:
First Name:ELAINE
Middle Name:M
Last Name:LUCERO
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1501 ALFREDO GARCIA CT NW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87107-7109
Mailing Address - Country:US
Mailing Address - Phone:505-344-7999
Mailing Address - Fax:
Practice Address - Street 1:2620 CARLISLE BLVD NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87110-2802
Practice Address - Country:US
Practice Address - Phone:505-884-0455
Practice Address - Fax:505-872-1842
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM4390183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist