Provider Demographics
NPI:1114234861
Name:LUCAS, BRIAN (PHARM D)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:
Last Name:LUCAS
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1327 MEADOWLARK DR
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27106-9817
Mailing Address - Country:US
Mailing Address - Phone:336-922-7066
Mailing Address - Fax:336-924-9433
Practice Address - Street 1:1327 MEADOWLARK DR
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27106-9817
Practice Address - Country:US
Practice Address - Phone:336-922-7066
Practice Address - Fax:336-924-9433
Is Sole Proprietor?:No
Enumeration Date:2010-09-01
Last Update Date:2017-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC176971835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy