Healthcare Provider Details

I. General information

NPI: 1144689381
Provider Name (Legal Business Name): JASON LUCAS RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/16/2016
Last Update Date: 08/19/2020
Certification Date: 08/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1949 W MARKET ST
AKRON OH
44313-6910
US

IV. Provider business mailing address

4477 SECRETARIAT CT
MEDINA OH
44256-7490
US

V. Phone/Fax

Practice location:
  • Phone: 330-867-5410
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number03338058
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number06013556
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: