Provider Demographics
NPI:1255421731
Name:LUCCI, LEO MICHAEL (BS)
Entity type:Individual
Prefix:MR
First Name:LEO
Middle Name:MICHAEL
Last Name:LUCCI
Suffix:
Gender:M
Credentials:BS
Other - Prefix:
Other - First Name:LEO
Other - Middle Name:
Other - Last Name:LUCCI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHARMACIST
Mailing Address - Street 1:2465 CIRCLEVILLE RD
Mailing Address - Street 2:UNIT 111
Mailing Address - City:STATE COLLEGE
Mailing Address - State:PA
Mailing Address - Zip Code:16803-3390
Mailing Address - Country:US
Mailing Address - Phone:814-861-5556
Mailing Address - Fax:
Practice Address - Street 1:2465 CIRCLEVILLE RD
Practice Address - Street 2:UNIT 111
Practice Address - City:STATE COLLEGE
Practice Address - State:PA
Practice Address - Zip Code:16803-3390
Practice Address - Country:US
Practice Address - Phone:814-861-5556
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP025948L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist