Provider Demographics
NPI:1982929352
Name:LUKOSE, HEATHER M (RPH)
Entity Type:Individual
Prefix:MS
First Name:HEATHER
Middle Name:M
Last Name:LUKOSE
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:MS
Other - First Name:JOEMOL
Other - Middle Name:
Other - Last Name:LUKOSE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BS
Mailing Address - Street 1:2324 BOSTON RD APT 15B
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10467-0827
Mailing Address - Country:US
Mailing Address - Phone:718-655-5860
Mailing Address - Fax:718-960-6676
Practice Address - Street 1:4422 3RD AVE
Practice Address - Street 2:ST.BARNABAS HOSPITAL, PHARMACY DEPARTMENT
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10457-2545
Practice Address - Country:US
Practice Address - Phone:718-960-5005
Practice Address - Fax:718-960-6676
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-29
Last Update Date:2010-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY048195183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY669280Medicaid
NY669280Medicaid
NY6692801972Medicare NSC
NY669280Medicare PIN
NY669280Medicare UPIN