Provider Demographics
NPI:1538783493
Name:LUEKENGA, RONALD SHAWN (PD)
Entity type:Individual
Prefix:DR
First Name:RONALD
Middle Name:SHAWN
Last Name:LUEKENGA
Suffix:
Gender:M
Credentials:PD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3339 E CHOLLA ST
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85028-2015
Mailing Address - Country:US
Mailing Address - Phone:870-356-9984
Mailing Address - Fax:
Practice Address - Street 1:3975 E THUNDERBIRD RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85032-5711
Practice Address - Country:US
Practice Address - Phone:602-923-0891
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-05
Last Update Date:2020-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS023150183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist