Provider Demographics
NPI:1972897296
Name:ROBERTS, LUCAS GARY (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:LUCAS
Middle Name:GARY
Last Name:ROBERTS
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:74-5455 MAKALA BLVD
Mailing Address - Street 2:
Mailing Address - City:KAILUA KONA
Mailing Address - State:HI
Mailing Address - Zip Code:96740-2727
Mailing Address - Country:US
Mailing Address - Phone:808-334-4021
Mailing Address - Fax:
Practice Address - Street 1:74-5455 MAKALA BLVD
Practice Address - Street 2:
Practice Address - City:KAILUA KONA
Practice Address - State:HI
Practice Address - Zip Code:96740-2727
Practice Address - Country:US
Practice Address - Phone:808-334-4021
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-03
Last Update Date:2011-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI2944183500000X
OR0011783183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist