Provider Demographics
NPI:1386952802
Name:COSGROVE, LUCAS JAMES (RPH)
Entity type:Individual
Prefix:MR
First Name:LUCAS
Middle Name:JAMES
Last Name:COSGROVE
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:7906 ERINTON DR
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23838-5543
Mailing Address - Country:US
Mailing Address - Phone:804-751-0161
Mailing Address - Fax:804-768-1685
Practice Address - Street 1:5500 LAKESIDE AVE
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23228-5719
Practice Address - Country:US
Practice Address - Phone:804-261-4855
Practice Address - Fax:804-262-3058
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-17
Last Update Date:2010-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202209749183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist