Provider Demographics
NPI:1659771913
Name:JUE, TUCK
Entity Type:Individual
Prefix:
First Name:TUCK
Middle Name:
Last Name:JUE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4200 SE 82ND AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97266-2943
Mailing Address - Country:US
Mailing Address - Phone:503-788-0400
Mailing Address - Fax:503-788-1117
Practice Address - Street 1:4200 SE 82ND AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97266-2943
Practice Address - Country:US
Practice Address - Phone:503-788-0400
Practice Address - Fax:503-788-1117
Is Sole Proprietor?:No
Enumeration Date:2014-08-23
Last Update Date:2014-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORRPH0008857183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist