Provider Demographics
NPI:1962862912
Name:TUBANDT, LUCILLE (RPH)
Entity Type:Individual
Prefix:
First Name:LUCILLE
Middle Name:
Last Name:TUBANDT
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 1:6300 MADDOX BLVD
Mailing Address - Street 2:
Mailing Address - City:CHINCOTEAGUE
Mailing Address - State:VA
Mailing Address - Zip Code:23336-2617
Mailing Address - Country:US
Mailing Address - Phone:757-336-3115
Mailing Address - Fax:
Practice Address - Street 1:6300 MADDOX BLVD
Practice Address - Street 2:
Practice Address - City:CHINCOTEAGUE
Practice Address - State:VA
Practice Address - Zip Code:23336-2617
Practice Address - Country:US
Practice Address - Phone:757-336-3115
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-03
Last Update Date:2016-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202211588183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist