Provider Demographics
NPI:1356017883
Name:LUECK, QUENTIN GARRETT (PHARMD)
Entity Type:Individual
Prefix:
First Name:QUENTIN
Middle Name:GARRETT
Last Name:LUECK
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 1:2900 ROOSEVELT RD
Mailing Address - Street 2:
Mailing Address - City:MARINETTE
Mailing Address - State:WI
Mailing Address - Zip Code:54143-4299
Mailing Address - Country:US
Mailing Address - Phone:715-735-5593
Mailing Address - Fax:
Practice Address - Street 1:2900 ROOSEVELT RD
Practice Address - Street 2:
Practice Address - City:MARINETTE
Practice Address - State:WI
Practice Address - Zip Code:54143-4299
Practice Address - Country:US
Practice Address - Phone:715-735-5593
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-16
Last Update Date:2021-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI21061-40183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist