Provider Demographics
NPI:1588935993
Name:LUSCAR, EBENS (RPH)
Entity type:Individual
Prefix:
First Name:EBENS
Middle Name:
Last Name:LUSCAR
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 1:612 WOOD RD
Mailing Address - Street 2:
Mailing Address - City:SEFFNER
Mailing Address - State:FL
Mailing Address - Zip Code:33584-5447
Mailing Address - Country:US
Mailing Address - Phone:813-451-7158
Mailing Address - Fax:
Practice Address - Street 1:8398 SHELDON RD
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33615-1609
Practice Address - Country:US
Practice Address - Phone:813-884-1487
Practice Address - Fax:813-886-2753
Is Sole Proprietor?:No
Enumeration Date:2012-01-17
Last Update Date:2012-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS 48634183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist