MEDICARE: MARK LUCARELLI

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	RP31243L	PA

General Provider Information

NPI Number	:	1164198222
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARK LUCARELLI

Provider Business Mailing Address
First Line	:	1315 COLD SPRING RD
Second Line	:
City	:	SCRANTON
State	:	PA
Zip	:	18508-1157
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1315 COLD SPRING RD
Second Line	:
City	:	SCRANTON
State	:	PA
Zip	:	18508-1113
Country	:	US
Telephone Number	:	570-383-8730
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/19/2021
Last Update Date	:	08/19/2021

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Directions to “ MARK LUCARELLI ” Practice Location

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