Healthcare Provider Details

I. General information

NPI: 1548668114
Provider Name (Legal Business Name): HEATHER ANNE LUCARELLI PHARM.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/15/2014
Last Update Date: 12/15/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4501 GRAND AVE
DULUTH MN
55807-2754
US

IV. Provider business mailing address

901 BOULDER DR APT 217
HERMANTOWN MN
55811-1791
US

V. Phone/Fax

Practice location:
  • Phone: 218-628-2897
  • Fax:
Mailing address:
  • Phone: 612-709-3790
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number121923
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number17726-40
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: