Provider Demographics
NPI:1558622944
Name:TUCKER, REYSHELLE MATANGUIHAN (RPH)
Entity Type:Individual
Prefix:MRS
First Name:REYSHELLE
Middle Name:MATANGUIHAN
Last Name:TUCKER
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:MS
Other - First Name:RESYHELLE
Other - Middle Name:OFTIAL
Other - Last Name:MATANGUIHAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RPH
Mailing Address - Street 1:6435 ALIANTE PKWY
Mailing Address - Street 2:
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89084-3196
Mailing Address - Country:US
Mailing Address - Phone:702-657-6508
Mailing Address - Fax:
Practice Address - Street 1:6435 ALIANTE PKWY
Practice Address - Street 2:
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89084-3196
Practice Address - Country:US
Practice Address - Phone:702-657-6508
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-02
Last Update Date:2023-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV18219183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist