Healthcare Provider Details

I. General information

NPI: 1164738738
Provider Name (Legal Business Name): LUCIE DONIKIAN PHARM D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2010
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2821 GLENWOOD AVENUE
ROCKFORD IL
61101
US

IV. Provider business mailing address

2821 GLENWOOD AVENUE
ROCKFORD IL
61103
US

V. Phone/Fax

Practice location:
  • Phone: 508-736-2599
  • Fax:
Mailing address:
  • Phone: 508-736-2599
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License NumberIND-888416
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPH233233
License Number StateMA
# 3
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number051296464
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: