Provider Demographics
NPI:1548613870
Name:LUCAS, PEYTON (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:PEYTON
Middle Name:
Last Name:LUCAS
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 1:2525 NICHOLS AVE
Mailing Address - Street 2:
Mailing Address - City:DYERSBURG
Mailing Address - State:TN
Mailing Address - Zip Code:38024-1657
Mailing Address - Country:US
Mailing Address - Phone:731-285-6030
Mailing Address - Fax:731-285-6031
Practice Address - Street 1:2525 NICHOLS AVE
Practice Address - Street 2:
Practice Address - City:DYERSBURG
Practice Address - State:TN
Practice Address - Zip Code:38024-1657
Practice Address - Country:US
Practice Address - Phone:731-285-6030
Practice Address - Fax:731-285-6031
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-21
Last Update Date:2016-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN40269183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist