Provider Demographics
NPI:1235320557
Name:GASCO, LUCAS (PHARMD)
Entity Type:Individual
Prefix:
First Name:LUCAS
Middle Name:
Last Name:GASCO
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:840 LINDEN AVE
Mailing Address - Street 2:
Mailing Address - City:BURLINGAME
Mailing Address - State:CA
Mailing Address - Zip Code:94010-2616
Mailing Address - Country:US
Mailing Address - Phone:650-759-4964
Mailing Address - Fax:
Practice Address - Street 1:52 MEDICAL GROUP UNIT 3690 APO, AE 09126-3690
Practice Address - Street 2:
Practice Address - City:APO
Practice Address - State:AE
Practice Address - Zip Code:09126-3690
Practice Address - Country:US
Practice Address - Phone:555-555-5555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-05
Last Update Date:2018-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA62925183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA62925OtherCALIFORNIA BOARD OF PHARMACY