Provider Demographics
NPI:1851372916
Name:LORD, WILLIAM S JR
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:S
Last Name:LORD
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1807 VIA DEL SOL NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87110-4959
Mailing Address - Country:US
Mailing Address - Phone:505-262-9002
Mailing Address - Fax:
Practice Address - Street 1:1807 VIA DEL SOL NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87110-4959
Practice Address - Country:US
Practice Address - Phone:505-262-9002
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-07
Last Update Date:2012-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM4255183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist