MEDICARE: DR. JACOB LUCHT

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	PS59776	FL

General Provider Information

NPI Number	:	1972152585
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JACOB LUCHT

Provider Business Mailing Address
First Line	:	3024 S OAKLAND FOREST DR APT 3102
Second Line	:
City	:	OAKLAND PARK
State	:	FL
Zip	:	33309-5612
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3400 N FEDERAL HWY
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33306-1036
Country	:	US
Telephone Number	:	954-564-9612
Fax Number	:

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

Provider Enumeration Date	:	09/06/2019
Last Update Date	:	09/06/2019

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