Provider Demographics
NPI:1174050868
Name:LUCAS, DALE
Entity type:Individual
Prefix:
First Name:DALE
Middle Name:
Last Name:LUCAS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1365 STONERIDGE DR
Mailing Address - Street 2:
Mailing Address - City:GAHANNA
Mailing Address - State:OH
Mailing Address - Zip Code:43230-8701
Mailing Address - Country:US
Mailing Address - Phone:614-418-1529
Mailing Address - Fax:614-416-2580
Practice Address - Street 1:1365 STONERIDGE DR
Practice Address - Street 2:
Practice Address - City:GAHANNA
Practice Address - State:OH
Practice Address - Zip Code:43230-8701
Practice Address - Country:US
Practice Address - Phone:614-418-1529
Practice Address - Fax:614-416-2580
Is Sole Proprietor?:No
Enumeration Date:2017-05-12
Last Update Date:2017-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03108942183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist