Healthcare Provider Details

I. General information

NPI: 1922024959
Provider Name (Legal Business Name): GREGG R LUKE R.PH.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/14/2006
Last Update Date: 09/12/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 E 1400 N STE K
NORTH LOGAN UT
84341-2450
US

IV. Provider business mailing address

5331 W 2400 S
MENDON UT
84325-9752
US

V. Phone/Fax

Practice location:
  • Phone: 435-755-8424
  • Fax: 453-755-8436
Mailing address:
  • Phone: 435-755-9553
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number152169-1701
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: