Provider Demographics
NPI:1710204714
Name:LASICK, KEVIN (PHARMD)
Entity Type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:
Last Name:LASICK
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 1:767 CABER DR
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:CA
Mailing Address - Zip Code:95648-2908
Mailing Address - Country:US
Mailing Address - Phone:916-645-7899
Mailing Address - Fax:
Practice Address - Street 1:767 CABER DR
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:CA
Practice Address - Zip Code:95648-2908
Practice Address - Country:US
Practice Address - Phone:916-645-7899
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-29
Last Update Date:2010-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA45966183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist