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General NPI Number Information
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NPI Number | 1366048522
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Entity Type | Individual
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Provider Name | LUCAS DERROUGH PHARM.D.
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Gender | Male
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Dates
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Enumeration Date | 12/11/2020
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Last Update Date | 12/11/2020
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Provider Practice Location Address
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Address Line | 103 N DIXIELAND RD
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City | ROGERS
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State | AR
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Zip | 72756-3203
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Country | US
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Telephone | 479-631-0210
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Fax |
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Provider Business Mailing Address
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Address Line | 903 CHARING CROSS
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City | CAVE SPRINGS
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State | AR
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Zip | 72718-5511
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Country | US
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Telephone | 903-826-9410
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | PD13185
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License Number State | AR
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