Provider Demographics
NPI:1699884577
Name:SURRATT, LUPE CAJERO (PHARMD)
Entity type:Individual
Prefix:MS
First Name:LUPE
Middle Name:CAJERO
Last Name:SURRATT
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:MS
Other - First Name:LUPE
Other - Middle Name:BURGNER
Other - Last Name:CAJERO-SURRATT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3486 W RED BIRD CT
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85745-5112
Mailing Address - Country:US
Mailing Address - Phone:520-628-1750
Mailing Address - Fax:
Practice Address - Street 1:3601 S 6TH AVE
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85723-0001
Practice Address - Country:US
Practice Address - Phone:520-792-1450
Practice Address - Fax:520-629-4700
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2019-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ102531835P1200X, 1835G0303X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835G0303XPharmacy Service ProvidersPharmacistGeriatric
No1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy