Healthcare Provider Details

I. General information

NPI: 1013539683
Provider Name (Legal Business Name): MEGAN L LUCAS PHARMD, MHA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/17/2020
Last Update Date: 05/17/2020
Certification Date: 05/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 N WALL ST
KANKAKEE IL
60901-2991
US

IV. Provider business mailing address

615 S POPLAR ST
MANTENO IL
60950-1693
US

V. Phone/Fax

Practice location:
  • Phone: 815-935-7256
  • Fax:
Mailing address:
  • Phone: 503-780-1166
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number9232
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: