Provider Demographics
NPI:1598544959
Name:FAJARDO DEL CID, ELVER (PHARM D)
Entity Type:Individual
Prefix:
First Name:ELVER
Middle Name:
Last Name:FAJARDO DEL CID
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1712 STRAWBERRY DR NE
Mailing Address - Street 2:
Mailing Address - City:RIO RANCHO
Mailing Address - State:NM
Mailing Address - Zip Code:87144-8007
Mailing Address - Country:US
Mailing Address - Phone:505-235-7537
Mailing Address - Fax:
Practice Address - Street 1:111 CENTRAL PARK SQ
Practice Address - Street 2:
Practice Address - City:LOS ALAMOS
Practice Address - State:NM
Practice Address - Zip Code:87544-4020
Practice Address - Country:US
Practice Address - Phone:505-661-9560
Practice Address - Fax:505-661-9599
Is Sole Proprietor?:No
Enumeration Date:2023-09-25
Last Update Date:2023-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMRP00010031183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist