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General NPI Number Information
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NPI Number | 1992439079
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Entity Type | Individual
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Provider Name | DYLAN LUCAS PHARMD
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Gender | Male
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Dates
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Enumeration Date | 07/13/2022
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Last Update Date | 07/13/2022
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Provider Practice Location Address
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Address Line | 2200 US HIGHWAY 50 E
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City | DAYTON
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State | NV
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Zip | 89403-7352
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Country | US
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Telephone | 775-246-0920
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Fax |
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Provider Business Mailing Address
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Address Line | 630 TRAVIS DR
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City | CARSON CITY
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State | NV
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Zip | 89701-6058
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Country | US
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Telephone | 702-335-8339
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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 | 21070
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License Number State | NV
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