Healthcare Provider Details

I. General information

NPI: 1902711534
Provider Name (Legal Business Name): LUCERNE PHARMACY1ST LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/18/2026
Last Update Date: 08/18/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6244 E HIGHWAY 20
LUCERNE CA
95458
US

IV. Provider business mailing address

PO BOX 1316
LUCERNE CA
95458-1316
US

V. Phone/Fax

Practice location:
  • Phone: 707-274-6643
  • Fax:
Mailing address:
  • Phone: 707-274-6643
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: HEE RYOUNG CHOI
Title or Position: PHARMACY OPS
Credential:
Phone: 914-650-4124