Provider Demographics
NPI:1407004088
Name:LOUCKS, NORMAN
Entity Type:Individual
Prefix:
First Name:NORMAN
Middle Name:
Last Name:LOUCKS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:705 STATE HIGHWAY 28
Mailing Address - Street 2:
Mailing Address - City:ONEONTA
Mailing Address - State:NY
Mailing Address - Zip Code:13820-3575
Mailing Address - Country:US
Mailing Address - Phone:607-432-0681
Mailing Address - Fax:607-431-2543
Practice Address - Street 1:705 STATE HIGHWAY 28
Practice Address - Street 2:
Practice Address - City:ONEONTA
Practice Address - State:NY
Practice Address - Zip Code:13820-3575
Practice Address - Country:US
Practice Address - Phone:607-432-0681
Practice Address - Fax:607-431-2543
Is Sole Proprietor?:No
Enumeration Date:2008-09-08
Last Update Date:2008-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY041364183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist