Provider Demographics
NPI:1316606031
Name:TRUJILLO, LANCE (PHARMD, BCPS)
Entity type:Individual
Prefix:DR
First Name:LANCE
Middle Name:
Last Name:TRUJILLO
Suffix:
Gender:M
Credentials:PHARMD, BCPS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:298 WALL AVE
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88001-7609
Mailing Address - Country:US
Mailing Address - Phone:575-636-7787
Mailing Address - Fax:
Practice Address - Street 1:2450 S TELSHOR BLVD
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88011-5076
Practice Address - Country:US
Practice Address - Phone:575-521-2235
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-09
Last Update Date:2023-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMRP000083931835P1200X, 1835E0208X
261QM2800X, 3336C0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835E0208XPharmacy Service ProvidersPharmacistEmergency Medicine
No1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy
No261QM2800XAmbulatory Health Care FacilitiesClinic/CenterMethadone
No3336C0002XSuppliersPharmacyClinic Pharmacy