Provider Demographics
NPI:1295908465
Name:LUCCI, VICTOR JOHN (RPH)
Entity type:Individual
Prefix:MR
First Name:VICTOR
Middle Name:JOHN
Last Name:LUCCI
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1026 UNION RD
Mailing Address - Street 2:
Mailing Address - City:WEST SENECA
Mailing Address - State:NY
Mailing Address - Zip Code:14224-3445
Mailing Address - Country:US
Mailing Address - Phone:716-712-0630
Mailing Address - Fax:716-712-0633
Practice Address - Street 1:1026 UNION RD
Practice Address - Street 2:
Practice Address - City:WEST SENECA
Practice Address - State:NY
Practice Address - Zip Code:14224-3445
Practice Address - Country:US
Practice Address - Phone:716-712-0630
Practice Address - Fax:716-712-0633
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-09
Last Update Date:2008-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY038835183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist