Healthcare Provider Details

I. General information

NPI: 1487055638
Provider Name (Legal Business Name): BARBARA ELIZABETH LUCKE PHARM.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/08/2014
Last Update Date: 09/08/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7901 METROPOLIS DR
AUSTIN TX
78744-3111
US

IV. Provider business mailing address

7901 METROPOLIS DR
AUSTIN TX
78744-3111
US

V. Phone/Fax

Practice location:
  • Phone: 512-934-2455
  • Fax:
Mailing address:
  • Phone: 512-934-2455
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number53543
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: