Provider Demographics
NPI:1780342659
Name:SUCHOCKI, LUKASZ (PHARMD)
Entity type:Individual
Prefix:
First Name:LUKASZ
Middle Name:
Last Name:SUCHOCKI
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 1:45810 KENSINGTON ST
Mailing Address - Street 2:
Mailing Address - City:UTICA
Mailing Address - State:MI
Mailing Address - Zip Code:48317-5954
Mailing Address - Country:US
Mailing Address - Phone:586-258-6464
Mailing Address - Fax:
Practice Address - Street 1:51037 VAN DYKE AVE
Practice Address - Street 2:
Practice Address - City:SHELBY TWP
Practice Address - State:MI
Practice Address - Zip Code:48316-4438
Practice Address - Country:US
Practice Address - Phone:586-739-1100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-07
Last Update Date:2021-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302414034183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist