Provider Demographics
NPI:1891017323
Name:LOUCKS, BRIAN STEVEN (RPH)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:STEVEN
Last Name:LOUCKS
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 CENTER ST
Mailing Address - Street 2:
Mailing Address - City:CUBA
Mailing Address - State:NY
Mailing Address - Zip Code:14727-1002
Mailing Address - Country:US
Mailing Address - Phone:585-968-3111
Mailing Address - Fax:585-968-7998
Practice Address - Street 1:2 CENTER ST
Practice Address - Street 2:
Practice Address - City:CUBA
Practice Address - State:NY
Practice Address - Zip Code:14727-1002
Practice Address - Country:US
Practice Address - Phone:585-968-3111
Practice Address - Fax:585-968-7998
Is Sole Proprietor?:No
Enumeration Date:2010-02-25
Last Update Date:2010-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY037444183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist