Healthcare Provider Details

I. General information

NPI: 1306341276
Provider Name (Legal Business Name): JEANELLE RENE LUCAS PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2018
Last Update Date: 03/24/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7300 STATE ROUTE 161 E
PLAIN CITY OH
43064-9276
US

IV. Provider business mailing address

12185 ANDREWS DR
PLAIN CITY OH
43064-9148
US

V. Phone/Fax

Practice location:
  • Phone: 614-733-5012
  • Fax:
Mailing address:
  • Phone: 248-459-9455
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number03328819
License Number StateOH

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: