Provider Demographics
NPI:1811611155
Name:EBIE, LUCAS
Entity type:Individual
Prefix:
First Name:LUCAS
Middle Name:
Last Name:EBIE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:505 N LAKE SHORE DR APT 5810
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-6451
Mailing Address - Country:US
Mailing Address - Phone:312-953-9792
Mailing Address - Fax:
Practice Address - Street 1:505 N LAKE SHORE DR APT 5810
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-6451
Practice Address - Country:US
Practice Address - Phone:312-953-9792
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-29
Last Update Date:2022-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy