Provider Demographics
NPI:1598754020
Name:TUCKER, WILLIAM ELLIOTT (RPH)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:ELLIOTT
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 1:1831 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:OTTAWA
Mailing Address - State:OH
Mailing Address - Zip Code:45875-1649
Mailing Address - Country:US
Mailing Address - Phone:419-523-6122
Mailing Address - Fax:419-523-6128
Practice Address - Street 1:1831 E MAIN ST
Practice Address - Street 2:
Practice Address - City:OTTAWA
Practice Address - State:OH
Practice Address - Zip Code:45875-1649
Practice Address - Country:US
Practice Address - Phone:419-523-6122
Practice Address - Fax:419-523-6128
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH08472183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist