Provider Demographics
NPI:1831569151
Name:LANSFORD, MICAH (PHARM D)
Entity type:Individual
Prefix:DR
First Name:MICAH
Middle Name:
Last Name:LANSFORD
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 1:601 E LLANO ESTACADO BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:CLOVIS
Mailing Address - State:NM
Mailing Address - Zip Code:88101-3780
Mailing Address - Country:US
Mailing Address - Phone:575-762-3848
Mailing Address - Fax:575-762-3840
Practice Address - Street 1:601 E LLANO ESTACADO BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:CLOVIS
Practice Address - State:NM
Practice Address - Zip Code:88101-3780
Practice Address - Country:US
Practice Address - Phone:575-762-3848
Practice Address - Fax:575-762-3840
Is Sole Proprietor?:No
Enumeration Date:2015-09-29
Last Update Date:2015-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMRP00008406183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist