Provider Demographics
NPI:1568935948
Name:WYCKOFF, LUKE ASHTON (PHARM D)
Entity Type:Individual
Prefix:
First Name:LUKE
Middle Name:ASHTON
Last Name:WYCKOFF
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:304 LONG CREEK LN
Mailing Address - Street 2:
Mailing Address - City:HAMPTON
Mailing Address - State:VA
Mailing Address - Zip Code:23664-1923
Mailing Address - Country:US
Mailing Address - Phone:757-651-5833
Mailing Address - Fax:
Practice Address - Street 1:304 LONG CREEK LN
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:VA
Practice Address - Zip Code:23664-1923
Practice Address - Country:US
Practice Address - Phone:757-651-5833
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-08
Last Update Date:2019-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202215805183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0202215805OtherVIRGINIA BOARD OF PHARMACY