Provider Demographics
NPI:1396330759
Name:LUCAS, ROBERT THOMAS (RPH)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:THOMAS
Last Name:LUCAS
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 1:503 WINDSOR LN
Mailing Address - Street 2:
Mailing Address - City:FLATWOODS
Mailing Address - State:KY
Mailing Address - Zip Code:41139-2173
Mailing Address - Country:US
Mailing Address - Phone:606-831-4054
Mailing Address - Fax:
Practice Address - Street 1:221 COUNTY ROAD 410
Practice Address - Street 2:
Practice Address - City:SOUTH POINT
Practice Address - State:OH
Practice Address - Zip Code:45680-7901
Practice Address - Country:US
Practice Address - Phone:740-894-0702
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-07
Last Update Date:2021-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP031244L183500000X
WVRP0005082183500000X
OH03322491183500000X
KY011133183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist