Provider Demographics
NPI:1245526615
Name:LUCKEY-THOMAS, SHAMBRESE NESHA (CPHT RPT)
Entity type:Individual
Prefix:MRS
First Name:SHAMBRESE
Middle Name:NESHA
Last Name:LUCKEY-THOMAS
Suffix:
Gender:F
Credentials:CPHT RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4180 DOYLE LN
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:TX
Mailing Address - Zip Code:75134-1726
Mailing Address - Country:US
Mailing Address - Phone:214-486-9045
Mailing Address - Fax:
Practice Address - Street 1:4180 DOYLE LN
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:TX
Practice Address - Zip Code:75134-1726
Practice Address - Country:US
Practice Address - Phone:214-486-9045
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-23
Last Update Date:2011-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX139010183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX139010OtherTSBP