Provider Demographics
NPI:1255740395
Name:TUCKER, TODD ANTHONY JR (PHARMD)
Entity type:Individual
Prefix:DR
First Name:TODD
Middle Name:ANTHONY
Last Name:TUCKER
Suffix:JR
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55555 BOSTON RD
Mailing Address - Street 2:
Mailing Address - City:BARNESVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43713-9733
Mailing Address - Country:US
Mailing Address - Phone:740-757-2384
Mailing Address - Fax:
Practice Address - Street 1:901 E MAIN ST
Practice Address - Street 2:
Practice Address - City:BARNESVILLE
Practice Address - State:OH
Practice Address - Zip Code:43713-1481
Practice Address - Country:US
Practice Address - Phone:740-425-1003
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-02
Last Update Date:2014-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03233776183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist