Healthcare Provider Details

I. General information

NPI: 1851109821
Provider Name (Legal Business Name): LUMICERA HEALTH SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/23/2024
Last Update Date: 12/03/2025
Certification Date: 12/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 TECHNOLOGY DR STE 100
IRVINE CA
92618-5314
US

IV. Provider business mailing address

310 INTEGRITY DR
MADISON WI
53717-1450
US

V. Phone/Fax

Practice location:
  • Phone: 855-847-3553
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336M0002X
TaxonomyMail Order Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: SHARON FAUST
Title or Position: CHIEF PHARMACY OFFICER
Credential:
Phone: 608-310-1811