MEDICARE: MR. LUCAS A STUMP PHARM D

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	03328900-3	OH

General Provider Information

NPI Number	:	1891003414
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. LUCAS A STUMP PHARM D

Provider Business Mailing Address
First Line	:	P.O. B 605
Second Line	:	110 E BUTLER STREET
City	:	FT. RECOVERY
State	:	OH
Zip	:	45846-0605
Country	:	US
Telephone Number	:	419-375-2323
Fax Number	:	419-375-4488

Provider Business Practice Location Address
First Line	:	110 E BUTLER STREET
Second Line	:	KAUP PHARMACY INC
City	:	FT. RECOVERY
State	:	OH
Zip	:	45846-0605
Country	:	US
Telephone Number	:	419-375-2323
Fax Number	:	419-375-4488

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

Provider Enumeration Date	:	09/16/2010
Last Update Date	:	09/24/2010

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