Provider Demographics
NPI:1821575200
Name:LUMICERA HEALTH SERVICES, LLC
Entity Type:Organization
Organization Name:LUMICERA HEALTH SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP, SPECIALTY PHARMACY
Authorized Official - Prefix:
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:
Authorized Official - Last Name:FAUST
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:608-310-1811
Mailing Address - Street 1:20501 SENECA MEADOWS PKWY STE 120
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:20876-7017
Mailing Address - Country:US
Mailing Address - Phone:877-885-1101
Mailing Address - Fax:877-885-1103
Practice Address - Street 1:20501 SENECA MEADOWS PKWY STE 120
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:MD
Practice Address - Zip Code:20876-7017
Practice Address - Country:US
Practice Address - Phone:877-885-1101
Practice Address - Fax:877-885-1103
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-27
Last Update Date:2023-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336S0011XSuppliersPharmacySpecialty Pharmacy