Provider Demographics
NPI:1518366442
Name:TUCKER, ELIZABETH ANN (RPH)
Entity Type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:ANN
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 1:1284 BRICE RD
Mailing Address - Street 2:ATTENTION PHARMACY
Mailing Address - City:REYNOLDSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43068-2311
Mailing Address - Country:US
Mailing Address - Phone:614-864-3636
Mailing Address - Fax:614-864-9044
Practice Address - Street 1:1284 BRICE RD
Practice Address - Street 2:ATTENTION PHARMACY
Practice Address - City:REYNOLDSBURG
Practice Address - State:OH
Practice Address - Zip Code:43068-2311
Practice Address - Country:US
Practice Address - Phone:614-864-3636
Practice Address - Fax:614-864-9044
Is Sole Proprietor?:No
Enumeration Date:2014-08-15
Last Update Date:2014-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03215107183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist