Provider Demographics
NPI:1770898736
Name:LUCAS, JENNIFER LIN (PHARMD)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:LIN
Last Name:LUCAS
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:DR
Other - First Name:JENNIFER
Other - Middle Name:LIN
Other - Last Name:SHANK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHARMD
Mailing Address - Street 1:4141 E JUDGE PEREZ DR
Mailing Address - Street 2:
Mailing Address - City:MERAUX
Mailing Address - State:LA
Mailing Address - Zip Code:70075-2670
Mailing Address - Country:US
Mailing Address - Phone:504-682-6738
Mailing Address - Fax:504-682-6744
Practice Address - Street 1:4141 E JUDGE PEREZ DRIVE
Practice Address - Street 2:
Practice Address - City:MERAUX
Practice Address - State:LA
Practice Address - Zip Code:70075-2670
Practice Address - Country:US
Practice Address - Phone:504-682-6738
Practice Address - Fax:504-682-6744
Is Sole Proprietor?:No
Enumeration Date:2010-08-16
Last Update Date:2010-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA18876183500000X
IL051291194183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist