Provider Demographics
NPI:1083299580
Name:LUCAS, PEGGY ANN (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:PEGGY
Middle Name:ANN
Last Name:LUCAS
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:303 NEW RIVERSIDE DR
Mailing Address - Street 2:
Mailing Address - City:SEVIERVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37862-5114
Mailing Address - Country:US
Mailing Address - Phone:865-908-5554
Mailing Address - Fax:865-908-6763
Practice Address - Street 1:303 NEW RIVERSIDE DR
Practice Address - Street 2:
Practice Address - City:SEVIERVILLE
Practice Address - State:TN
Practice Address - Zip Code:37862-5114
Practice Address - Country:US
Practice Address - Phone:865-908-5554
Practice Address - Fax:865-908-6763
Is Sole Proprietor?:No
Enumeration Date:2021-03-16
Last Update Date:2021-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN35747183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist