Provider Demographics
NPI:1487787941
Name:MILLER, LUCAS B (PHARMD, RPH)
Entity type:Individual
Prefix:
First Name:LUCAS
Middle Name:B
Last Name:MILLER
Suffix:
Gender:M
Credentials:PHARMD, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3002 SUNSET DR
Mailing Address - Street 2:
Mailing Address - City:JOPLIN
Mailing Address - State:MO
Mailing Address - Zip Code:64804-1380
Mailing Address - Country:US
Mailing Address - Phone:417-483-5262
Mailing Address - Fax:
Practice Address - Street 1:1410 E 7TH ST
Practice Address - Street 2:
Practice Address - City:JOPLIN
Practice Address - State:MO
Practice Address - Zip Code:64801-2045
Practice Address - Country:US
Practice Address - Phone:417-624-3270
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2004009919183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist