Provider Demographics
NPI:1366726317
Name:LUKSCH, ROBERT
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:LUKSCH
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 1:29520 HARPER AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT CLAIR SHORES
Mailing Address - State:MI
Mailing Address - Zip Code:48081-1211
Mailing Address - Country:US
Mailing Address - Phone:586-447-3208
Mailing Address - Fax:586-447-1467
Practice Address - Street 1:29520 HARPER AVE
Practice Address - Street 2:
Practice Address - City:SAINT CLAIR SHORES
Practice Address - State:MI
Practice Address - Zip Code:48081-1211
Practice Address - Country:US
Practice Address - Phone:586-447-3208
Practice Address - Fax:586-447-1467
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-07
Last Update Date:2011-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302028840183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist