Provider Demographics
NPI:1740574607
Name:LUCAS, JUDITH GRANTHAM (RPH)
Entity Type:Individual
Prefix:MRS
First Name:JUDITH
Middle Name:GRANTHAM
Last Name:LUCAS
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1356 LITTLE RIVER RD
Mailing Address - Street 2:
Mailing Address - City:ASHEBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27205-1217
Mailing Address - Country:US
Mailing Address - Phone:336-381-2319
Mailing Address - Fax:
Practice Address - Street 1:440 E DIXIE DR
Practice Address - Street 2:
Practice Address - City:ASHEBORO
Practice Address - State:NC
Practice Address - Zip Code:27203-6860
Practice Address - Country:US
Practice Address - Phone:336-625-2314
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-07
Last Update Date:2011-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9577183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist