Provider Demographics
NPI:1477899136
Name:KUBACKI, LUKE ANTHONY (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:LUKE
Middle Name:ANTHONY
Last Name:KUBACKI
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 1:842 NATIONAL RD
Mailing Address - Street 2:
Mailing Address - City:WHEELING
Mailing Address - State:WV
Mailing Address - Zip Code:26003-6439
Mailing Address - Country:US
Mailing Address - Phone:304-232-3410
Mailing Address - Fax:304-232-5116
Practice Address - Street 1:842 NATIONAL RD
Practice Address - Street 2:
Practice Address - City:WHEELING
Practice Address - State:WV
Practice Address - Zip Code:26003-6439
Practice Address - Country:US
Practice Address - Phone:304-232-3410
Practice Address - Fax:304-232-5116
Is Sole Proprietor?:No
Enumeration Date:2012-12-27
Last Update Date:2016-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVWV0007970183500000X, 183500000X
PARP446860183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist