Provider Demographics
NPI:1861077752
Name:LUCCO, CHARITY LEE (PHARMD)
Entity type:Individual
Prefix:DR
First Name:CHARITY
Middle Name:LEE
Last Name:LUCCO
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3840 N SHERMAN DR
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46226-4462
Mailing Address - Country:US
Mailing Address - Phone:317-541-3438
Mailing Address - Fax:317-541-3418
Practice Address - Street 1:3840 N SHERMAN DR
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46226-4462
Practice Address - Country:US
Practice Address - Phone:317-541-3438
Practice Address - Fax:317-541-3418
Is Sole Proprietor?:No
Enumeration Date:2021-03-12
Last Update Date:2021-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26023324A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist