Provider Demographics
NPI:1578995494
Name:BERENBROK, LUCAS (PHARMD)
Entity Type:Individual
Prefix:
First Name:LUCAS
Middle Name:
Last Name:BERENBROK
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 1:26 S 28TH ST
Mailing Address - Street 2:APT 203
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15203-2346
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:636 SALK HALL
Practice Address - Street 2:3501 TERRACE ST
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15261-1906
Practice Address - Country:US
Practice Address - Phone:412-624-8109
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-01
Last Update Date:2016-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP448933183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist