Provider Demographics
NPI:1114151966
Name:LUKASIK, RONALD S II
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:S
Last Name:LUKASIK
Suffix:II
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1330 MICHIGAN AVE
Mailing Address - Street 2:
Mailing Address - City:WATERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43566-1011
Mailing Address - Country:US
Mailing Address - Phone:419-878-8384
Mailing Address - Fax:419-878-5820
Practice Address - Street 1:1330 MICHIGAN AVE
Practice Address - Street 2:
Practice Address - City:WATERVILLE
Practice Address - State:OH
Practice Address - Zip Code:43566-1011
Practice Address - Country:US
Practice Address - Phone:419-878-8384
Practice Address - Fax:419-878-5820
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-08
Last Update Date:2009-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03222970183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist