Provider Demographics
NPI:1942798095
Name:LUCK ENTERPRISES LLC
Entity type:Organization
Organization Name:LUCK ENTERPRISES LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PIC
Authorized Official - Prefix:
Authorized Official - First Name:SABRINA
Authorized Official - Middle Name:K
Authorized Official - Last Name:GRIGGS
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:830-257-0732
Mailing Address - Street 1:1228 BANDERA HWY
Mailing Address - Street 2:
Mailing Address - City:KERRVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78028-9640
Mailing Address - Country:US
Mailing Address - Phone:830-257-0732
Mailing Address - Fax:830-257-8486
Practice Address - Street 1:1228 BANDERA HWY
Practice Address - Street 2:
Practice Address - City:KERRVILLE
Practice Address - State:TX
Practice Address - Zip Code:78028-9640
Practice Address - Country:US
Practice Address - Phone:830-257-0732
Practice Address - Fax:830-257-8486
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-24
Last Update Date:2018-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX319033336C0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0004XSuppliersPharmacyCompounding Pharmacy