Provider Demographics
NPI:1609191527
Name:LUKACH, ANDREA BETH
Entity Type:Individual
Prefix:MS
First Name:ANDREA
Middle Name:BETH
Last Name:LUKACH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15180 TAMIAMI TRL
Mailing Address - Street 2:
Mailing Address - City:NORTH PORT
Mailing Address - State:FL
Mailing Address - Zip Code:34287-2742
Mailing Address - Country:US
Mailing Address - Phone:941-423-6100
Mailing Address - Fax:941-423-6700
Practice Address - Street 1:15180 TAMIAMI TRL
Practice Address - Street 2:
Practice Address - City:NORTH PORT
Practice Address - State:FL
Practice Address - Zip Code:34287-2742
Practice Address - Country:US
Practice Address - Phone:941-423-6100
Practice Address - Fax:941-423-6700
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-03
Last Update Date:2013-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP440319183500000X
FLPS47306183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist