Provider Demographics
NPI:1376279224
Name:TUCKER, ERIN KATHERINE (RPH)
Entity Type:Individual
Prefix:DR
First Name:ERIN
Middle Name:KATHERINE
Last Name:TUCKER
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14805 N OUTER 40 RD STE 140
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:63017-6060
Mailing Address - Country:US
Mailing Address - Phone:636-733-7333
Mailing Address - Fax:636-733-7334
Practice Address - Street 1:14805 N OUTER 40 RD STE 140
Practice Address - Street 2:
Practice Address - City:CHESTERFIELD
Practice Address - State:MO
Practice Address - Zip Code:63017-6060
Practice Address - Country:US
Practice Address - Phone:636-733-7333
Practice Address - Fax:636-733-7334
Is Sole Proprietor?:No
Enumeration Date:2022-07-25
Last Update Date:2022-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2008028420183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO2008028420Medicaid