Provider Demographics
NPI:1194011569
Name:LUCORE, LAUREL M (PHARMD)
Entity Type:Individual
Prefix:
First Name:LAUREL
Middle Name:M
Last Name:LUCORE
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 1:1000 NICOLLET MALL
Mailing Address - Street 2:TPN-13412
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55403-2542
Mailing Address - Country:US
Mailing Address - Phone:612-696-1584
Mailing Address - Fax:
Practice Address - Street 1:1000 NICOLLET MALL
Practice Address - Street 2:TPN-13412
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55403-2542
Practice Address - Country:US
Practice Address - Phone:612-696-1584
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-23
Last Update Date:2015-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26023625A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist