Provider Demographics
NPI:1104606003
Name:DOTSON, LUKE EDWARD (PHARMD)
Entity type:Individual
Prefix:DR
First Name:LUKE
Middle Name:EDWARD
Last Name:DOTSON
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 1:7876 N 500 W
Mailing Address - Street 2:
Mailing Address - City:RIDGEVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47380-9651
Mailing Address - Country:US
Mailing Address - Phone:765-625-0679
Mailing Address - Fax:
Practice Address - Street 1:7950 W JEFFERSON BLVD
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46804-4160
Practice Address - Country:US
Practice Address - Phone:765-625-0679
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-29
Last Update Date:2023-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26030462A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist