Provider Demographics
NPI:1801476635
Name:O'NEIL, LUCAS (PHARMD)
Entity type:Individual
Prefix:
First Name:LUCAS
Middle Name:
Last Name:O'NEIL
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 1:15483 S DIXIE HWY
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:MI
Mailing Address - Zip Code:48161-3953
Mailing Address - Country:US
Mailing Address - Phone:734-243-5656
Mailing Address - Fax:
Practice Address - Street 1:15483 S DIXIE HWY
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:MI
Practice Address - Zip Code:48161-3953
Practice Address - Country:US
Practice Address - Phone:734-243-5656
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-14
Last Update Date:2021-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03440446183500000X
MI5302043707183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist