Healthcare Provider Details

I. General information

NPI: 1063321073
Provider Name (Legal Business Name): LUMICERA HEALTH SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/04/2026
Last Update Date: 09/04/2026
Certification Date: 09/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20501 SENECA MEADOWS PKWY STE 120
GERMANTOWN MD
20876-7017
US

IV. Provider business mailing address

20501 SENECA MEADOWS PKWY STE 120
GERMANTOWN MD
20876-7017
US

V. Phone/Fax

Practice location:
  • Phone: 877-885-1101
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336M0002X
TaxonomyMail Order Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: SHARON FAUST
Title or Position: CHIEF PHARMACY OFFICER
Credential:
Phone: 608-310-1811