Provider Demographics
NPI:1730526740
Name:TRUJILLO, LAURA JEAN (RPH)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:JEAN
Last Name:TRUJILLO
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:JEAN
Other - Last Name:LUTZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RPH
Mailing Address - Street 1:4611 S ENSENADA ST
Mailing Address - Street 2:
Mailing Address - City:CENTENNIAL
Mailing Address - State:CO
Mailing Address - Zip Code:80015-5823
Mailing Address - Country:US
Mailing Address - Phone:720-560-2352
Mailing Address - Fax:
Practice Address - Street 1:4611 S ENSENADA ST
Practice Address - Street 2:
Practice Address - City:CENTENNIAL
Practice Address - State:CO
Practice Address - Zip Code:80015-5823
Practice Address - Country:US
Practice Address - Phone:720-560-2352
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-30
Last Update Date:2013-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO11936183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist