Healthcare Provider Details

I. General information

NPI: 1548892425
Provider Name (Legal Business Name): LUKAS WILLIAM HANNON PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/07/2020
Last Update Date: 02/07/2020
Certification Date: 02/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

428 MEMORIAL DRIVE EXT
GREER SC
29651-1818
US

IV. Provider business mailing address

110 ASCOT DR
GREER SC
29651-1006
US

V. Phone/Fax

Practice location:
  • Phone: 864-877-4281
  • Fax: 864-877-4077
Mailing address:
  • Phone: 864-616-9569
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number41950
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: