Basic Information
| Provider Information | |||||||||
| NPI: | 1477634004 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LUCIUS | ||||||||
| FirstName: | DAVID | ||||||||
| MiddleName: | |||||||||
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| Credential: | PHARM D.RPH | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4881 SUGAR MAPLE DR | ||||||||
| Address2: | |||||||||
| City: | WPAFB | ||||||||
| State: | OH | ||||||||
| PostalCode: | 454335546 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 4881 SUGAR MAPLE DR | ||||||||
| Address2: | |||||||||
| City: | WPAFB | ||||||||
| State: | OH | ||||||||
| PostalCode: | 454335546 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9372579014 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/18/2006 | ||||||||
| LastUpdateDate: | 03/13/2009 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 183500000X | 03-2-25126 | OH | Y | Pharmacy Service Providers | Pharmacist |
No ID Information.