=====================================================
General NPI Number Information
=====================================================
NPI Number | 1073482535
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LUC PHARMACY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/03/2025
-----------------------------------------------------
Last Update Date | 11/03/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 418 N UTICA AVE STE B
-----------------------------------------------------
City | LUBBOCK
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 79416-3035
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 806-771-5882
-----------------------------------------------------
Fax | 806-722-1079
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 418 N UTICA AVE STE B
-----------------------------------------------------
City | LUBBOCK
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 79416-3035
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 806-771-5882
-----------------------------------------------------
Fax | 806-722-1079
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRATOR
-----------------------------------------------------
Name | STACY BROTHERS
-----------------------------------------------------
Credential | FNP
-----------------------------------------------------
Telephone | 806-786-0307
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------