MEDICARE: MR. MICHAEL DAVID DELUCA RPH

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	012045	KY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	012045	OTHER	KY	PHARMACY

General Provider Information

NPI Number	:	1205455987
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MICHAEL DAVID DELUCA RPH

Provider Business Mailing Address
First Line	:	3908 LAUREL OAK LN
Second Line	:
City	:	LEXINGTON
State	:	KY
Zip	:	40514-1732
Country	:	US
Telephone Number	:	859-421-4347
Fax Number	:

Provider Business Practice Location Address
First Line	:	3908 LAUREL OAK LN
Second Line	:
City	:	LEXINGTON
State	:	KY
Zip	:	40514-1732
Country	:	US
Telephone Number	:	859-421-4347
Fax Number	:

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

Provider Enumeration Date	:	04/13/2020
Last Update Date	:	04/14/2020

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