Provider Demographics
NPI:1710200761
Name:LUCANIE, RALPH
Entity Type:Individual
Prefix:MR
First Name:RALPH
Middle Name:
Last Name:LUCANIE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32 DESANCTIS DR
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND MILLS
Mailing Address - State:NY
Mailing Address - Zip Code:10930-3420
Mailing Address - Country:US
Mailing Address - Phone:845-928-7807
Mailing Address - Fax:
Practice Address - Street 1:32 DESANCTIS DR
Practice Address - Street 2:
Practice Address - City:HIGHLAND MILLS
Practice Address - State:NY
Practice Address - Zip Code:10930-3420
Practice Address - Country:US
Practice Address - Phone:845-928-7807
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-03-04
Last Update Date:2010-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY037875183500000X
NJ28RI01742200183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist