Healthcare Provider Details

I. General information

NPI: 1629903893
Provider Name (Legal Business Name): LUCAS MORRICAL
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/17/2026
Last Update Date: 06/17/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12735 W CAPITOL DR
BROOKFIELD WI
53005-2442
US

IV. Provider business mailing address

11011 W NORTH AVE APT 269
WAUWATOSA WI
53226-2268
US

V. Phone/Fax

Practice location:
  • Phone: 262-783-7302
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number22346-40
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: