Healthcare Provider Details

I. General information

NPI: 1144931874
Provider Name (Legal Business Name): LUCAS ANTHONY GUNTHER PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/13/2022
Last Update Date: 12/13/2022
Certification Date: 12/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3809 E WATKINS ST
PHOENIX AZ
85034-7264
US

IV. Provider business mailing address

15608 N 71ST ST APT 253
SCOTTSDALE AZ
85254-5464
US

V. Phone/Fax

Practice location:
  • Phone: 855-745-5725
  • Fax:
Mailing address:
  • Phone: 623-208-2698
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberS026190
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: