Healthcare Provider Details

I. General information

NPI: 1528056009
Provider Name (Legal Business Name): LUCAS R SARGENT PHARMD, CGP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/10/2005
Last Update Date: 08/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8264 W STATE ROUTE 41
COVINGTON OH
45318-1248
US

IV. Provider business mailing address

695 LOXLEY LN
TROY OH
45373-7801
US

V. Phone/Fax

Practice location:
  • Phone: 800-232-4239
  • Fax:
Mailing address:
  • Phone: 937-524-2449
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number03-2-25077
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number5302034066
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number26021012A
License Number StateIN
# 4
Primary TaxonomyN
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number03-2-25077
License Number StateOH
# 5
Primary TaxonomyN
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number5302034066
License Number StateMI
# 6
Primary TaxonomyN
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number26021012A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: