Provider Demographics
NPI:1265767818
Name:KIMANGA, LUCAS NYABERO (PHARMD)
Entity type:Individual
Prefix:DR
First Name:LUCAS
Middle Name:NYABERO
Last Name:KIMANGA
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 1:9718 E GELDING DR
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85260-3883
Mailing Address - Country:US
Mailing Address - Phone:206-605-6643
Mailing Address - Fax:480-445-9078
Practice Address - Street 1:10450 N 90TH ST
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85258-4406
Practice Address - Country:US
Practice Address - Phone:480-661-0238
Practice Address - Fax:480-391-3076
Is Sole Proprietor?:No
Enumeration Date:2009-10-14
Last Update Date:2009-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS16395183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZS16395OtherPHARMACIST LICENCE NUMBER