Provider Demographics
NPI:1093001752
Name:MUKKA, LOIS A (RPH)
Entity Type:Individual
Prefix:
First Name:LOIS
Middle Name:A
Last Name:MUKKA
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5601 BARDSTOWN RD
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40291-1911
Mailing Address - Country:US
Mailing Address - Phone:502-239-5320
Mailing Address - Fax:502-239-7970
Practice Address - Street 1:5601 BARDSTOWN RD
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40291-1911
Practice Address - Country:US
Practice Address - Phone:502-239-5320
Practice Address - Fax:502-239-7970
Is Sole Proprietor?:No
Enumeration Date:2011-06-21
Last Update Date:2011-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY015234183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist