Provider Demographics
NPI:1477042828
Name:LUCCHESI, ENRICO JOHN (PHARMD)
Entity Type:Individual
Prefix:MR
First Name:ENRICO
Middle Name:JOHN
Last Name:LUCCHESI
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 1:3132 E VIRGINIA AVE
Mailing Address - Street 2:
Mailing Address - City:WEST COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91791-2337
Mailing Address - Country:US
Mailing Address - Phone:626-824-0062
Mailing Address - Fax:
Practice Address - Street 1:12234 PALMDALE RD
Practice Address - Street 2:
Practice Address - City:VICTORVILLE
Practice Address - State:CA
Practice Address - Zip Code:92392-9418
Practice Address - Country:US
Practice Address - Phone:760-493-3047
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-01
Last Update Date:2018-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA28646183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist