Provider Demographics
NPI:1083985766
Name:LUKES FAMILY PHARMACY LLC
Entity Type:Organization
Organization Name:LUKES FAMILY PHARMACY LLC
Other - Org Name:LUKES FAMILY PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:LUCAS
Authorized Official - Middle Name:ROY
Authorized Official - Last Name:SNELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-788-4970
Mailing Address - Street 1:101 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HAILEY
Mailing Address - State:ID
Mailing Address - Zip Code:83333-8408
Mailing Address - Country:US
Mailing Address - Phone:208-788-4970
Mailing Address - Fax:208-788-5791
Practice Address - Street 1:101 S MAIN ST
Practice Address - Street 2:
Practice Address - City:HAILEY
Practice Address - State:ID
Practice Address - Zip Code:83333-8408
Practice Address - Country:US
Practice Address - Phone:208-788-4970
Practice Address - Fax:208-788-5791
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-26
Last Update Date:2012-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
6683300001Medicare NSC