Provider Demographics
NPI:1669889853
Name:HOUSTON, LUKE MICHAEL (PHARM D)
Entity type:Individual
Prefix:
First Name:LUKE
Middle Name:MICHAEL
Last Name:HOUSTON
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5108 CLEVELAND BLVD
Mailing Address - Street 2:
Mailing Address - City:CALDWELL
Mailing Address - State:ID
Mailing Address - Zip Code:83607-8002
Mailing Address - Country:US
Mailing Address - Phone:208-455-0800
Mailing Address - Fax:208-455-3539
Practice Address - Street 1:5108 CLEVELAND BLVD
Practice Address - Street 2:
Practice Address - City:CALDWELL
Practice Address - State:ID
Practice Address - Zip Code:83607-8002
Practice Address - Country:US
Practice Address - Phone:208-455-0800
Practice Address - Fax:208-455-3539
Is Sole Proprietor?:No
Enumeration Date:2014-07-19
Last Update Date:2014-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDP5897183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist