Provider Demographics
NPI:1609283837
Name:SMITH, LUCAS (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:LUCAS
Middle Name:
Last Name:SMITH
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:PO BOX 1670
Mailing Address - Street 2:403 US HIGHWAY 24 SOUTH
Mailing Address - City:BUENA VISTA
Mailing Address - State:CO
Mailing Address - Zip Code:81211-1670
Mailing Address - Country:US
Mailing Address - Phone:719-395-2481
Mailing Address - Fax:719-395-2484
Practice Address - Street 1:403 US HIGHWAY 24 SOUTH
Practice Address - Street 2:
Practice Address - City:BUENA VISTA
Practice Address - State:CO
Practice Address - Zip Code:81211
Practice Address - Country:US
Practice Address - Phone:719-395-2481
Practice Address - Fax:719-395-2484
Is Sole Proprietor?:No
Enumeration Date:2014-07-21
Last Update Date:2023-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO203431835P0018X, 1835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
COCO1102OtherCOMPREHENSIVE CONTRACEPTIVE EDUCATION PROVIDING CERTIFICATION FOR CO PHARMACIST