Provider Information for 1316011794
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LUCERNE PHARMACY INC
Other Names:Doing Business As:LUCERNE PHARMACYOrganization Subpart: NO
NPI: 1316011794
Last Updated: 2016-03-03
Certification Date:
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Details
Name | Value | ||||||||||||
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NPI | 1316011794 | ||||||||||||
Enumeration Date | 2006-11-20 | ||||||||||||
NPI Type | NPI-2 Organization | ||||||||||||
Status | Active | ||||||||||||
Authorized Official Information | Name: GAYLAN SHEPHERD RPH Title: CEO and PIC Phone: 7072746643 | ||||||||||||
Mailing Address | PO BOX 1316 LUCERNE, CA 95458-1316 United States Phone: 707-274-6643 | Fax:707-274-2469 | ||||||||||||
Primary Practice Address | 6244 E HIGHWAY 20 LUCERNE, CA 95458-1316 United States Phone: 707-274-6643 | Fax:707-274-2469 | ||||||||||||
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