MEDICARE: CRYSTAL LUKOSE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	43185	FL

General Provider Information

NPI Number	:	1659172914
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CRYSTAL LUKOSE

Provider Business Mailing Address
First Line	:	12592 NW 53RD ST
Second Line	:
City	:	CORAL SPRINGS
State	:	FL
Zip	:	33076-3419
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	12592 NW 53RD ST
Second Line	:
City	:	CORAL SPRINGS
State	:	FL
Zip	:	33076-3419
Country	:	US
Telephone Number	:	954-439-6475
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/22/2025
Last Update Date	:	03/22/2025

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Directions to “ CRYSTAL LUKOSE ” Practice Location

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