Provider Demographics
NPI:1952999534
Name:LUCKY'S PHARMACY LLC
Entity Type:Organization
Organization Name:LUCKY'S PHARMACY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SAMIR
Authorized Official - Middle Name:
Authorized Official - Last Name:FALDU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-329-3681
Mailing Address - Street 1:5240 WARWICK WOODS TRL
Mailing Address - Street 2:
Mailing Address - City:GRAND BLANC
Mailing Address - State:MI
Mailing Address - Zip Code:48439-9591
Mailing Address - Country:US
Mailing Address - Phone:610-329-3681
Mailing Address - Fax:
Practice Address - Street 1:810 S DORT HWY STE B
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48503-2898
Practice Address - Country:US
Practice Address - Phone:610-329-3681
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-08
Last Update Date:2021-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy