Provider Demographics
NPI:1235439134
Name:TUCKER, RICHARD LEE (RPH)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:LEE
Last Name:TUCKER
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:477 W NAPA ST
Mailing Address - Street 2:
Mailing Address - City:SONOMA
Mailing Address - State:CA
Mailing Address - Zip Code:95476-6551
Mailing Address - Country:US
Mailing Address - Phone:707-996-3697
Mailing Address - Fax:707-996-0758
Practice Address - Street 1:477 W NAPA ST
Practice Address - Street 2:
Practice Address - City:SONOMA
Practice Address - State:CA
Practice Address - Zip Code:95476-6551
Practice Address - Country:US
Practice Address - Phone:707-996-3697
Practice Address - Fax:707-996-0758
Is Sole Proprietor?:No
Enumeration Date:2010-10-25
Last Update Date:2010-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA25491183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist