Healthcare Provider Details

I. General information

NPI: 1790036747
Provider Name (Legal Business Name): LUCAS ALEXANDER HARRELL PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2012
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 S WATSON RD
BUCKEYE AZ
85326-6303
US

IV. Provider business mailing address

1300 S WATSON RD
BUCKEYE AZ
85326-6303
US

V. Phone/Fax

Practice location:
  • Phone: 623-691-6633
  • Fax: 623-691-6627
Mailing address:
  • Phone: 623-691-6633
  • Fax: 623-691-6627

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License NumberS019312
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: