Provider Demographics
NPI:1104009034
Name:LUCCHESE, MICHELE ANNEMARIE (RPH)
Entity Type:Individual
Prefix:MRS
First Name:MICHELE
Middle Name:ANNEMARIE
Last Name:LUCCHESE
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 1:1931 HERING AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10461-1835
Mailing Address - Country:US
Mailing Address - Phone:718-892-1661
Mailing Address - Fax:
Practice Address - Street 1:1535 2ND AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10075-0504
Practice Address - Country:US
Practice Address - Phone:212-327-4757
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-12-13
Last Update Date:2007-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY043354183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist