Provider Demographics
NPI:1962730432
Name:LUKAZEWSKI, ALAN ANTHONY (RPH,CDE,CGP)
Entity type:Individual
Prefix:MR
First Name:ALAN
Middle Name:ANTHONY
Last Name:LUKAZEWSKI
Suffix:
Gender:M
Credentials:RPH,CDE,CGP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45 NOB HILL RD
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53713-2195
Mailing Address - Country:US
Mailing Address - Phone:608-661-6676
Mailing Address - Fax:608-276-9119
Practice Address - Street 1:6201 MINERAL POINT RD
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53705-4503
Practice Address - Country:US
Practice Address - Phone:608-661-6676
Practice Address - Fax:608-276-9119
Is Sole Proprietor?:No
Enumeration Date:2009-11-21
Last Update Date:2016-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI11081-0401835G0303X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835G0303XPharmacy Service ProvidersPharmacistGeriatric