Provider Demographics
NPI:1356484372
Name:LUCAS, ROBERT BRIAN SR (RPH)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:BRIAN
Last Name:LUCAS
Suffix:SR
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 1:2530 SANDHAVEN CT
Mailing Address - Street 2:
Mailing Address - City:GREEN COVE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32043-5293
Mailing Address - Country:US
Mailing Address - Phone:904-529-1273
Mailing Address - Fax:
Practice Address - Street 1:865 HIBERNIA RD
Practice Address - Street 2:SUITE 200
Practice Address - City:FLEMING ISLAND
Practice Address - State:FL
Practice Address - Zip Code:32003-8707
Practice Address - Country:US
Practice Address - Phone:904-529-1273
Practice Address - Fax:904-529-8851
Is Sole Proprietor?:No
Enumeration Date:2007-02-15
Last Update Date:2008-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS39101183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist