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Provider Information for 1316011794


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LUCERNE PHARMACY INC

Other Names:  
Doing Business As: 
LUCERNE PHARMACY

Organization Subpart: NO

NPI: 1316011794
Last Updated: 2016-03-03
Certification Date:

Details

NameValue
NPI1316011794
Enumeration Date2006-11-20
NPI TypeNPI-2 Organization
StatusActive
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
 
Secondary Practice Address(es)
Health Information Exchange
Endpoint TypeEndpointEndpoint DescriptionUseContent TypeAffiliationEndpoint Location
Other Identifiers
IssuerStateNumberOther Issuer
Other (non-Medicare)1989861PK
Taxonomy
Primary TaxonomySelected TaxonomyStateLicense Number
No 333600000X - Pharmacy
Yes 3336C0003X - Pharmacy - Community/Retail PharmacyCAPHY46594