Provider Demographics
NPI:1841576808
Name:HALLADAY, LUCIANA F (RPH)
Entity Type:Individual
Prefix:MRS
First Name:LUCIANA
Middle Name:F
Last Name:HALLADAY
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 1:1221 PENN AVE N # 2
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55411-3632
Mailing Address - Country:US
Mailing Address - Phone:612-521-8473
Mailing Address - Fax:612-922-5398
Practice Address - Street 1:3240 W LAKE ST
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55416-4512
Practice Address - Country:US
Practice Address - Phone:612-922-8436
Practice Address - Fax:612-922-5398
Is Sole Proprietor?:No
Enumeration Date:2011-10-21
Last Update Date:2011-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN118451183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist