Provider Demographics
NPI:1871180844
Name:LUCAS, HARRIETT DEMOS (RPH)
Entity Type:Individual
Prefix:
First Name:HARRIETT
Middle Name:DEMOS
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 1:1810 GREENWOOD RD SW
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24015-2820
Mailing Address - Country:US
Mailing Address - Phone:540-871-6086
Mailing Address - Fax:
Practice Address - Street 1:4400 BRAMBLETON AVE
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24018-3427
Practice Address - Country:US
Practice Address - Phone:540-989-6633
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-24
Last Update Date:2020-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202009945183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist