Provider Demographics
NPI:1104401686
Name:LUBKE, PAMELA J (PHARMD)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:J
Last Name:LUBKE
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 1:305 RASH LN
Mailing Address - Street 2:
Mailing Address - City:TERRELL
Mailing Address - State:TX
Mailing Address - Zip Code:75160-1417
Mailing Address - Country:US
Mailing Address - Phone:214-693-3518
Mailing Address - Fax:
Practice Address - Street 1:1410 E MAIN ST
Practice Address - Street 2:
Practice Address - City:EASTLAND
Practice Address - State:TX
Practice Address - Zip Code:76448-3023
Practice Address - Country:US
Practice Address - Phone:254-629-3371
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-16
Last Update Date:2021-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX29072183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist