Healthcare Provider Details

I. General information

NPI: 1083985766
Provider Name (Legal Business Name): LUKES FAMILY PHARMACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/26/2012
Last Update Date: 10/19/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 S MAIN ST
HAILEY ID
83333-8408
US

IV. Provider business mailing address

101 S MAIN ST
HAILEY ID
83333-8408
US

V. Phone/Fax

Practice location:
  • Phone: 208-788-4970
  • Fax: 208-788-5791
Mailing address:
  • Phone: 208-788-4970
  • Fax: 208-788-5791

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number StateID

VIII. Authorized Official

Name: MR. LUCAS ROY SNELL
Title or Position: PHARMACIST/OWNER
Credential:
Phone: 208-788-4970