Provider Demographics
NPI:1548668114
Name:LUCARELLI, HEATHER ANNE (PHARMD)
Entity type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:ANNE
Last Name:LUCARELLI
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 BOULDER DR APT 217
Mailing Address - Street 2:
Mailing Address - City:HERMANTOWN
Mailing Address - State:MN
Mailing Address - Zip Code:55811-1791
Mailing Address - Country:US
Mailing Address - Phone:612-709-3790
Mailing Address - Fax:
Practice Address - Street 1:4501 GRAND AVE
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55807-2754
Practice Address - Country:US
Practice Address - Phone:218-628-2897
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-15
Last Update Date:2014-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN121923183500000X
WI17726-40183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist