Provider Demographics
NPI:1922346550
Name:KUECKER, ERIN S (PHARMD)
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:S
Last Name:KUECKER
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 1:601 LANHAM RD
Mailing Address - Street 2:
Mailing Address - City:SANDERS
Mailing Address - State:KY
Mailing Address - Zip Code:41083-9770
Mailing Address - Country:US
Mailing Address - Phone:407-921-3308
Mailing Address - Fax:
Practice Address - Street 1:601 LANHAM RD
Practice Address - Street 2:
Practice Address - City:SANDERS
Practice Address - State:KY
Practice Address - Zip Code:41083-9770
Practice Address - Country:US
Practice Address - Phone:407-921-3308
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-16
Last Update Date:2016-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS49332183500000X
KY017628183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist