Provider Demographics
NPI:1184095564
Name:LUTHER, JOSEPH BRANDON
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:BRANDON
Last Name:LUTHER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:JOSEPH
Other - Middle Name:BRANDON
Other - Last Name:LUTHER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHARM D
Mailing Address - Street 1:528 ELY BLVD S
Mailing Address - Street 2:
Mailing Address - City:PETALUMA
Mailing Address - State:CA
Mailing Address - Zip Code:94954-3814
Mailing Address - Country:US
Mailing Address - Phone:707-616-8409
Mailing Address - Fax:
Practice Address - Street 1:7514 REDWOOD BLVD
Practice Address - Street 2:SUITE 104
Practice Address - City:NOVATO
Practice Address - State:CA
Practice Address - Zip Code:94945-7710
Practice Address - Country:US
Practice Address - Phone:415-892-3700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-12
Last Update Date:2015-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA64113183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist