Provider Demographics
NPI:1285286849
Name:LUKE, WILLIAM ALEXANDER BRYAN (RPH)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:ALEXANDER BRYAN
Last Name:LUKE
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 PIERCE ST
Mailing Address - Street 2:
Mailing Address - City:SIOUX CITY
Mailing Address - State:IA
Mailing Address - Zip Code:51101-1487
Mailing Address - Country:US
Mailing Address - Phone:712-252-4669
Mailing Address - Fax:712-252-4906
Practice Address - Street 1:100 PIERCE ST
Practice Address - Street 2:
Practice Address - City:SIOUX CITY
Practice Address - State:IA
Practice Address - Zip Code:51101-1434
Practice Address - Country:US
Practice Address - Phone:712-252-4669
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-14
Last Update Date:2019-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA23537183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA23537OtherIOWA BOARD OF PHARMACY