Provider Demographics
NPI:1851681852
Name:BODE, LUCILLE SUSAN (RPH)
Entity Type:Individual
Prefix:MS
First Name:LUCILLE
Middle Name:SUSAN
Last Name:BODE
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:MS
Other - First Name:LUCILLE
Other - Middle Name:SUSAN
Other - Last Name:KIELY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RPH
Mailing Address - Street 1:3101 CLAYS MILL RD
Mailing Address - Street 2:114
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40503-2772
Mailing Address - Country:US
Mailing Address - Phone:859-223-9202
Mailing Address - Fax:859-224-4552
Practice Address - Street 1:3101 CLAYS MILL RD
Practice Address - Street 2:114
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40503-2772
Practice Address - Country:US
Practice Address - Phone:859-223-9202
Practice Address - Fax:859-224-4552
Is Sole Proprietor?:No
Enumeration Date:2011-04-11
Last Update Date:2011-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY0011774183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist