Provider Demographics
NPI:1073159976
Name:RUCKER, MATTHEW JAMES (RPH,PHARMD)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:JAMES
Last Name:RUCKER
Suffix:
Gender:M
Credentials:RPH,PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2015 STATE RD STE B
Mailing Address - Street 2:
Mailing Address - City:CUYAHOGA FALLS
Mailing Address - State:OH
Mailing Address - Zip Code:44223-1425
Mailing Address - Country:US
Mailing Address - Phone:330-926-5941
Mailing Address - Fax:330-940-4241
Practice Address - Street 1:2015 STATE RD STE B
Practice Address - Street 2:
Practice Address - City:CUYAHOGA FALLS
Practice Address - State:OH
Practice Address - Zip Code:44223-1425
Practice Address - Country:US
Practice Address - Phone:330-926-5941
Practice Address - Fax:330-940-4241
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-26
Last Update Date:2019-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03326857183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist