Provider Demographics
NPI:1073947636
Name:LUMICERA HEALTH SERVICES, LLC
Entity Type:Organization
Organization Name:LUMICERA HEALTH SERVICES, LLC
Other - Org Name:LUMICERA HEALTH SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR, PHARMACY SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:
Authorized Official - Last Name:FAUST
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:608-310-1811
Mailing Address - Street 1:310 INTEGRITY DRIVE
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53717
Mailing Address - Country:US
Mailing Address - Phone:855-847-3553
Mailing Address - Fax:855-847-3558
Practice Address - Street 1:310 INTEGRITY DR
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53717-1416
Practice Address - Country:US
Practice Address - Phone:855-847-3553
Practice Address - Fax:855-847-3558
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-30
Last Update Date:2023-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336S0011XSuppliersPharmacySpecialty Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2141834OtherPK