Provider Demographics
NPI:1184615510
Name:LANDRUM, JOHN SARGENT (RPH, MS)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:SARGENT
Last Name:LANDRUM
Suffix:
Gender:M
Credentials:RPH, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1765 POMONA DR
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88011-4919
Mailing Address - Country:US
Mailing Address - Phone:505-522-0675
Mailing Address - Fax:505-646-6428
Practice Address - Street 1:1765 POMONA DR
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88011-4919
Practice Address - Country:US
Practice Address - Phone:505-522-0675
Practice Address - Fax:505-646-6428
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM4051183500000X, 1835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered183500000XPharmacy Service ProvidersPharmacist
Not Answered1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy