Provider Demographics
NPI:1831471457
Name:TUCKER, MICHAEL A (PHARMD, RPH)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:A
Last Name:TUCKER
Suffix:
Gender:M
Credentials:PHARMD, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7338 DIXIE HWY
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40258-3722
Mailing Address - Country:US
Mailing Address - Phone:502-937-3747
Mailing Address - Fax:502-937-3747
Practice Address - Street 1:7338 DIXIE HWY
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40258-3722
Practice Address - Country:US
Practice Address - Phone:502-937-3747
Practice Address - Fax:502-937-3747
Is Sole Proprietor?:No
Enumeration Date:2011-09-10
Last Update Date:2011-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY014520183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist