Provider Demographics
NPI:1447560297
Name:GLARUM, LUCAS BRADLEY (PHARMD)
Entity Type:Individual
Prefix:
First Name:LUCAS
Middle Name:BRADLEY
Last Name:GLARUM
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 1:619 DAKOTA AVE
Mailing Address - Street 2:
Mailing Address - City:WAHPETON
Mailing Address - State:ND
Mailing Address - Zip Code:58075-4325
Mailing Address - Country:US
Mailing Address - Phone:701-642-6223
Mailing Address - Fax:701-642-8839
Practice Address - Street 1:619 DAKOTA AVE
Practice Address - Street 2:
Practice Address - City:WAHPETON
Practice Address - State:ND
Practice Address - Zip Code:58075-4325
Practice Address - Country:US
Practice Address - Phone:701-642-6223
Practice Address - Fax:701-642-8839
Is Sole Proprietor?:No
Enumeration Date:2010-10-14
Last Update Date:2024-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND5254183500000X
MN119968183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist