Provider Demographics
NPI:1902400930
Name:LUCKMAN, DAWN MARIE
Entity Type:Individual
Prefix:
First Name:DAWN
Middle Name:MARIE
Last Name:LUCKMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2037 WEST BLVD
Mailing Address - Street 2:
Mailing Address - City:MALAGA
Mailing Address - State:NJ
Mailing Address - Zip Code:08328-4443
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2037 WEST BLVD
Practice Address - Street 2:
Practice Address - City:MALAGA
Practice Address - State:NJ
Practice Address - Zip Code:08328-4443
Practice Address - Country:US
Practice Address - Phone:856-694-3951
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-30
Last Update Date:2020-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI02902100183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist