Provider Demographics
NPI:1821493933
Name:LUCKETT, SHANTERRICA CHERELLE (PHARMD)
Entity Type:Individual
Prefix:MRS
First Name:SHANTERRICA
Middle Name:CHERELLE
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 1:10 POPE AVE
Mailing Address - Street 2:
Mailing Address - City:HILTON HEAD ISLAND
Mailing Address - State:SC
Mailing Address - Zip Code:29928-4719
Mailing Address - Country:US
Mailing Address - Phone:843-785-7786
Mailing Address - Fax:843-785-8963
Practice Address - Street 1:10 POPE AVE
Practice Address - Street 2:
Practice Address - City:HILTON HEAD ISLAND
Practice Address - State:SC
Practice Address - Zip Code:29928-4719
Practice Address - Country:US
Practice Address - Phone:843-785-7786
Practice Address - Fax:843-785-8963
Is Sole Proprietor?:No
Enumeration Date:2014-10-31
Last Update Date:2014-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD35733183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist