Provider Demographics
NPI:1710255922
Name:LUKAS, LAURIE J
Entity Type:Individual
Prefix:
First Name:LAURIE
Middle Name:J
Last Name:LUKAS
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 1:50 SAINT JAMES BLVD
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01104-2918
Mailing Address - Country:US
Mailing Address - Phone:413-733-3002
Mailing Address - Fax:
Practice Address - Street 1:50 SAINT JAMES BLVD
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01104-2918
Practice Address - Country:US
Practice Address - Phone:413-733-3002
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-02
Last Update Date:2011-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA21929183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist