Basic Information
| Provider Information | |||||||||
| NPI: | 1093819179 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LAUCKA | ||||||||
| FirstName: | PAUL | ||||||||
| MiddleName: | JAMES | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | PHARM D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 26 MILLIGAN LN | ||||||||
| Address2: | |||||||||
| City: | JOHNSON CITY | ||||||||
| State: | TN | ||||||||
| PostalCode: | 376019204 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7274152714 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | JAMES A. QUILLEN VAMC | ||||||||
| Address2: | |||||||||
| City: | MOUNTAIN HOME | ||||||||
| State: | TN | ||||||||
| PostalCode: | 37684 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4239261171 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/11/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 183500000X | PS40749 | FL | Y | Pharmacy Service Providers | Pharmacist |
No ID Information.