=====================================================
General NPI Number Information
=====================================================
NPI Number | 1548668114
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | HEATHER ANNE LUCARELLI PHARM.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/15/2014
-----------------------------------------------------
Last Update Date | 12/15/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4501 GRAND AVE
-----------------------------------------------------
City | DULUTH
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55807-2754
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 218-628-2897
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 901 BOULDER DR APT 217
-----------------------------------------------------
City | HERMANTOWN
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55811-1791
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 612-709-3790
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 121923
-----------------------------------------------------
License Number State | MN
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 17726-40
-----------------------------------------------------
License Number State | WI
-----------------------------------------------------