Provider Demographics
NPI:1366048522
Name:DERROUGH, LUCAS (PHARMD)
Entity type:Individual
Prefix:DR
First Name:LUCAS
Middle Name:
Last Name:DERROUGH
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:903 CHARING CROSS
Mailing Address - Street 2:
Mailing Address - City:CAVE SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:72718-5511
Mailing Address - Country:US
Mailing Address - Phone:903-826-9410
Mailing Address - Fax:
Practice Address - Street 1:103 N DIXIELAND RD
Practice Address - Street 2:
Practice Address - City:ROGERS
Practice Address - State:AR
Practice Address - Zip Code:72756-3203
Practice Address - Country:US
Practice Address - Phone:479-631-0210
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-11
Last Update Date:2020-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPD13185183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist