Provider Demographics
NPI:1346470457
Name:BOE, LUCAS ANDREW (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:LUCAS
Middle Name:ANDREW
Last Name:BOE
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 1:132 SOUTH MAIN STREET
Mailing Address - Street 2:PO BOX 172
Mailing Address - City:LUCK
Mailing Address - State:WI
Mailing Address - Zip Code:54853-0172
Mailing Address - Country:US
Mailing Address - Phone:715-472-2122
Mailing Address - Fax:
Practice Address - Street 1:132 SOUTH MAIN STREET
Practice Address - Street 2:
Practice Address - City:LUCK
Practice Address - State:WI
Practice Address - Zip Code:54853-0172
Practice Address - Country:US
Practice Address - Phone:715-472-2122
Practice Address - Fax:715-472-4423
Is Sole Proprietor?:No
Enumeration Date:2009-07-23
Last Update Date:2010-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI15659-40183500000X
MN119842183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist