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Individual

JAIME LEA LUSK

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
CPHT

Contact information

Practice address
409 S 13TH ST, BELLEVILLE, IL 62220-1840
(702) 343-5055
Mailing address
409 S 13TH ST, BELLEVILLE, IL 62220-1840
(702) 343-5055

Taxonomy

Speciality
Code
Description
License number
State
183700000X
Pharmacy Technician
Primary
049155332
IL
183700000X
Pharmacy Technician
2008026976
MO

Other

Enumeration date
08/18/2009
Last updated
08/18/2009
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