Provider Demographics
NPI:1992332787
Name:LUCA, JOSEPH (RPH)
Entity type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:
Last Name:LUCA
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 1:109 TENNYSON LN
Mailing Address - Street 2:
Mailing Address - City:NORTH WALES
Mailing Address - State:PA
Mailing Address - Zip Code:19454-1641
Mailing Address - Country:US
Mailing Address - Phone:267-261-2452
Mailing Address - Fax:717-947-9695
Practice Address - Street 1:109 TENNYSON LN
Practice Address - Street 2:
Practice Address - City:NORTH WALES
Practice Address - State:PA
Practice Address - Zip Code:19454-1641
Practice Address - Country:US
Practice Address - Phone:267-261-2452
Practice Address - Fax:717-947-9695
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-24
Last Update Date:2020-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP442700183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PARP442700OtherPHARMACIST LICENSE
NY041690-01OtherPHARMACIST LICENSE