Provider Demographics
NPI:1154158863
Name:NICOLAU, LUCAS A (PHARMD, RPH)
Entity type:Individual
Prefix:
First Name:LUCAS
Middle Name:A
Last Name:NICOLAU
Suffix:
Gender:M
Credentials:PHARMD, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1086 WILLETT AVE
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:RI
Mailing Address - Zip Code:02915-2067
Mailing Address - Country:US
Mailing Address - Phone:401-433-5710
Mailing Address - Fax:401-433-5713
Practice Address - Street 1:1086 WILLETT AVE
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:RI
Practice Address - Zip Code:02915-2067
Practice Address - Country:US
Practice Address - Phone:401-433-5710
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-17
Last Update Date:2024-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTPCT.0016816183500000X
RIRPH06705183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist