Healthcare Provider Details

I. General information

NPI: 1962757096
Provider Name (Legal Business Name): KATELYN ELIZABETH LUCKMAN PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2012
Last Update Date: 06/27/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 ELM ST
LUDLOW KY
41016-1520
US

IV. Provider business mailing address

130 ELM ST
LUDLOW KY
41016-1520
US

V. Phone/Fax

Practice location:
  • Phone: 859-261-2210
  • Fax:
Mailing address:
  • Phone: 859-261-2210
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number03131766
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number016496
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: