Healthcare Provider Details

I. General information

NPI: 1134221328
Provider Name (Legal Business Name): PAUL VINCENT LAUCKA PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/01/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10000 BAY PINES BLVD
BAY PINES FL
33744
US

IV. Provider business mailing address

6330 3RD PALM PT
ST PETE BEACH FL
33706-2122
US

V. Phone/Fax

Practice location:
  • Phone: 727-398-6661
  • Fax:
Mailing address:
  • Phone: 727-363-0135
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number20569
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: