Provider Demographics
NPI:1679280044
Name:LUCKETT, LEANNA (PHARMD)
Entity Type:Individual
Prefix:
First Name:LEANNA
Middle Name:
Last Name:LUCKETT
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:555 FIESTA CT
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:94533-7773
Mailing Address - Country:US
Mailing Address - Phone:479-970-8380
Mailing Address - Fax:
Practice Address - Street 1:681 LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:NAPA
Practice Address - State:CA
Practice Address - Zip Code:94558-3612
Practice Address - Country:US
Practice Address - Phone:707-224-7120
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-03
Last Update Date:2022-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA87000183500000X
ARPD11663183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist