Provider Demographics
NPI:1932482635
Name:LUKASZEWICZ, JUDY BOCCO
Entity Type:Individual
Prefix:MS
First Name:JUDY
Middle Name:BOCCO
Last Name:LUKASZEWICZ
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:JUDY
Other - Middle Name:ANN
Other - Last Name:BOCCO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RPH
Mailing Address - Street 1:90 PEREGRINE DR
Mailing Address - Street 2:
Mailing Address - City:VOORHEES
Mailing Address - State:NJ
Mailing Address - Zip Code:08043-1661
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:404 ROUTE 73 S
Practice Address - Street 2:
Practice Address - City:EVESHAM
Practice Address - State:NJ
Practice Address - Zip Code:08053-2048
Practice Address - Country:US
Practice Address - Phone:856-988-6164
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-20
Last Update Date:2011-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RIO1528400183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist