Provider Demographics
NPI:1992011183
Name:LUCAS, WILLIAM G
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:G
Last Name:LUCAS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 DEPOT RD
Mailing Address - Street 2:
Mailing Address - City:FALMOUTH
Mailing Address - State:ME
Mailing Address - Zip Code:04105-1715
Mailing Address - Country:US
Mailing Address - Phone:207-781-4414
Mailing Address - Fax:207-781-3097
Practice Address - Street 1:33 DEPOT RD
Practice Address - Street 2:
Practice Address - City:FALMOUTH
Practice Address - State:ME
Practice Address - Zip Code:04105-1715
Practice Address - Country:US
Practice Address - Phone:207-781-4414
Practice Address - Fax:207-781-3097
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-25
Last Update Date:2010-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPR4815183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist