Provider Demographics
NPI:1831609395
Name:LUCKOW, SCOTT (PHARMD, RPH)
Entity type:Individual
Prefix:
First Name:SCOTT
Middle Name:
Last Name:LUCKOW
Suffix:
Gender:M
Credentials:PHARMD, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2401 HASSELL RD STE 1525
Mailing Address - Street 2:
Mailing Address - City:HOFFMAN ESTATES
Mailing Address - State:IL
Mailing Address - Zip Code:60169-2000
Mailing Address - Country:US
Mailing Address - Phone:800-783-9655
Mailing Address - Fax:877-770-4179
Practice Address - Street 1:2401 HASSELL RD STE 1525
Practice Address - Street 2:
Practice Address - City:HOFFMAN ESTATES
Practice Address - State:IL
Practice Address - Zip Code:60169-2000
Practice Address - Country:US
Practice Address - Phone:800-783-9655
Practice Address - Fax:877-770-4179
Is Sole Proprietor?:No
Enumeration Date:2017-10-10
Last Update Date:2017-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051.041005183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist