Provider Demographics
NPI:1568053866
Name:FUENTES, STEVEN RAY (PHARMD,RPH)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:RAY
Last Name:FUENTES
Suffix:
Gender:M
Credentials:PHARMD,RPH
Other - Prefix:
Other - First Name:STEVEN
Other - Middle Name:RAY
Other - Last Name:FUENTES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHARMD, RPH
Mailing Address - Street 1:3011 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88001-1164
Mailing Address - Country:US
Mailing Address - Phone:575-647-8878
Mailing Address - Fax:
Practice Address - Street 1:3011 N MAIN ST
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88001-1164
Practice Address - Country:US
Practice Address - Phone:575-647-8878
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-29
Last Update Date:2022-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX69313183500000X
CA77383183500000X
NM9495183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist