Provider Demographics
NPI:1558898940
Name:LUCIANO, STEPHEN (PHARMD)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:
Last Name:LUCIANO
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 1:97 MCALISTER FARM RD
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04103-5946
Mailing Address - Country:US
Mailing Address - Phone:207-775-0631
Mailing Address - Fax:
Practice Address - Street 1:97 MCALISTER FARM RD
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04103-5946
Practice Address - Country:US
Practice Address - Phone:207-775-0631
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-16
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPIC46699183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist