Provider Demographics
NPI:1801416995
Name:TUCKER, JILL E (RPH)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:E
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 1:5884 AUBREY LN
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:IN
Mailing Address - Zip Code:47905-9303
Mailing Address - Country:US
Mailing Address - Phone:765-404-4308
Mailing Address - Fax:317-968-1010
Practice Address - Street 1:1327 VETERANS MEMORIAL PKWY E
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47905-8917
Practice Address - Country:US
Practice Address - Phone:765-838-6771
Practice Address - Fax:317-968-1010
Is Sole Proprietor?:No
Enumeration Date:2020-04-20
Last Update Date:2020-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26020034A1835P2201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P2201XPharmacy Service ProvidersPharmacistAmbulatory Care