Provider Demographics
NPI:1750838553
Name:LUCERO, MARISELA ARELLANO (RPH)
Entity Type:Individual
Prefix:MRS
First Name:MARISELA
Middle Name:ARELLANO
Last Name:LUCERO
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2020 CALLE PAJARO AZUL NW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87120-3102
Mailing Address - Country:US
Mailing Address - Phone:505-899-2268
Mailing Address - Fax:
Practice Address - Street 1:2020 CALLE PAJARO AZUL NW
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87120-3102
Practice Address - Country:US
Practice Address - Phone:505-899-2268
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-09
Last Update Date:2016-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM5243183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist