Provider Demographics
NPI:1225342306
Name:LUKASZEWICZ, THADDEUS (RPH)
Entity Type:Individual
Prefix:
First Name:THADDEUS
Middle Name:
Last Name:LUKASZEWICZ
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:90 PEREGRINE DR
Mailing Address - Street 2:
Mailing Address - City:VOORHEES
Mailing Address - State:NJ
Mailing Address - Zip Code:08043-1661
Mailing Address - Country:US
Mailing Address - Phone:856-424-7262
Mailing Address - Fax:
Practice Address - Street 1:100 PEMBERTON BROWNS MILL RD
Practice Address - Street 2:
Practice Address - City:BROWNS MILLS
Practice Address - State:NJ
Practice Address - Zip Code:08015-3127
Practice Address - Country:US
Practice Address - Phone:609-893-1437
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-02
Last Update Date:2010-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI01534900183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist