Provider Demographics
NPI:1578857645
Name:WURSTER, TRICIA JEAN (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:TRICIA
Middle Name:JEAN
Last Name:WURSTER
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10720 SW VILLAGE PKWY
Mailing Address - Street 2:T2248
Mailing Address - City:PORT SAINT LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34987-2188
Mailing Address - Country:US
Mailing Address - Phone:772-293-6153
Mailing Address - Fax:772-293-6153
Practice Address - Street 1:10720 SW VILLAGE PKWY
Practice Address - Street 2:T2248
Practice Address - City:PORT SAINT LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34987-2188
Practice Address - Country:US
Practice Address - Phone:772-293-6153
Practice Address - Fax:772-293-6153
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-06
Last Update Date:2011-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS42369183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist