Provider Demographics
NPI:1598073074
Name:LUCERO, ROBERT A (RPH)
Entity type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:A
Last Name:LUCERO
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 N GUADALUPE ST
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87501-1456
Mailing Address - Country:US
Mailing Address - Phone:505-982-4806
Mailing Address - Fax:505-982-5138
Practice Address - Street 1:600 N GUADALUPE ST
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87501-1456
Practice Address - Country:US
Practice Address - Phone:505-982-4806
Practice Address - Fax:505-982-5138
Is Sole Proprietor?:No
Enumeration Date:2010-09-19
Last Update Date:2010-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMRP00005164183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist