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General NPI Number Information
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NPI Number | 1679280044
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Entity Type | Individual
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Provider Name | LEANNA LUCKETT PHARMD
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Gender | Female
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Dates
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Enumeration Date | 11/03/2022
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Last Update Date | 11/03/2022
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Provider Practice Location Address
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Address Line | 681 LINCOLN AVE
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City | NAPA
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State | CA
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Zip | 94558-3612
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Country | US
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Telephone | 707-224-7120
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Fax |
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Provider Business Mailing Address
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Address Line | 555 FIESTA CT
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City | FAIRFIELD
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State | CA
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Zip | 94533-7773
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Country | US
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Telephone | 479-970-8380
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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 | 87000
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | PD11663
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License Number State | AR
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