Healthcare Provider Details

I. General information

NPI: 1275153314
Provider Name (Legal Business Name): CHRISTOPHER LUCAS PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/18/2020
Last Update Date: 04/18/2020
Certification Date: 04/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 COFFEE RD
MODESTO CA
95355-2803
US

IV. Provider business mailing address

2613 BARDOLINO LN
MODESTO CA
95356-0626
US

V. Phone/Fax

Practice location:
  • Phone: 209-572-7064
  • Fax:
Mailing address:
  • Phone: 562-743-7716
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835X0200X
TaxonomyOncology Pharmacist
License Number63108
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: