Provider Demographics
NPI:1700917614
Name:LUCEY, ELLEN MARIE (RPH)
Entity Type:Individual
Prefix:
First Name:ELLEN
Middle Name:MARIE
Last Name:LUCEY
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5715 N BAY RIDGE AVE
Mailing Address - Street 2:
Mailing Address - City:WHITEFISH BAY
Mailing Address - State:WI
Mailing Address - Zip Code:53217-4719
Mailing Address - Country:US
Mailing Address - Phone:414-550-8868
Mailing Address - Fax:
Practice Address - Street 1:795 WOODLAKE RD STE C
Practice Address - Street 2:
Practice Address - City:KOHLER
Practice Address - State:WI
Practice Address - Zip Code:53044-1315
Practice Address - Country:US
Practice Address - Phone:920-457-7644
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI11403183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist