1275097511 NPI number — LAUREN LUCE PHARMD, RPH

Table of content: LAUREN LUCE PHARMD, RPH (NPI 1275097511)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275097511 NPI number — LAUREN LUCE PHARMD, RPH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LUCE
Provider First Name:
LAUREN
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PHARMD, RPH
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MACKS
Provider Other First Name:
LAUREN
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
PHARMD, RPH
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1275097511
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/30/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1011 RIVER HILLS RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BEAVERCREEK
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45430-1123
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
248-996-2739
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
106 N MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEW CARLISLE
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45344-1835
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
937-667-1122
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/30/2019

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1835P2201X , with the licence number:  03135853 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 03135853 . This is a "PHARMACIST LICENSE NUMBER" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".




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