Provider Demographics
NPI:1306341276
Name:LUCAS, JEANELLE RENE (PHARMD)
Entity type:Individual
Prefix:
First Name:JEANELLE
Middle Name:RENE
Last Name:LUCAS
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12185 ANDREWS DR
Mailing Address - Street 2:
Mailing Address - City:PLAIN CITY
Mailing Address - State:OH
Mailing Address - Zip Code:43064-9148
Mailing Address - Country:US
Mailing Address - Phone:248-459-9455
Mailing Address - Fax:
Practice Address - Street 1:7300 STATE ROUTE 161 E
Practice Address - Street 2:
Practice Address - City:PLAIN CITY
Practice Address - State:OH
Practice Address - Zip Code:43064-9276
Practice Address - Country:US
Practice Address - Phone:614-733-5012
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-24
Last Update Date:2018-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03328819183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist