Provider Demographics
NPI:1043057540
Name:EDENFIELD, LUCAS (PHARMD)
Entity type:Individual
Prefix:DR
First Name:LUCAS
Middle Name:
Last Name:EDENFIELD
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:63 N MILL ST
Mailing Address - Street 2:
Mailing Address - City:NEW SALEM
Mailing Address - State:PA
Mailing Address - Zip Code:15468-1115
Mailing Address - Country:US
Mailing Address - Phone:724-317-3106
Mailing Address - Fax:
Practice Address - Street 1:897 CHESTNUT RIDGE RD
Practice Address - Street 2:
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26505-2704
Practice Address - Country:US
Practice Address - Phone:304-598-2534
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-11
Last Update Date:2024-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVRP0014188183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist