Healthcare Provider Details

I. General information

NPI: 1023141140
Provider Name (Legal Business Name): LUCAS CADE COLSON PHARM. D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/14/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 8TH AVE
FORT WORTH TX
76104-4110
US

IV. Provider business mailing address

8841 TYLER DR
LANTANA TX
76226-6529
US

V. Phone/Fax

Practice location:
  • Phone: 817-922-2074
  • Fax: 817-922-1799
Mailing address:
  • Phone: 817-922-2074
  • Fax: 817-922-1799

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number44774
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: