Provider Demographics
NPI:1770935892
Name:KREFT, TUCKER (PHARMD)
Entity type:Individual
Prefix:
First Name:TUCKER
Middle Name:
Last Name:KREFT
Suffix:
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 1:116 MONTGOMERY PL
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:ND
Mailing Address - Zip Code:58504-9310
Mailing Address - Country:US
Mailing Address - Phone:701-866-4575
Mailing Address - Fax:
Practice Address - Street 1:300 N 7TH ST
Practice Address - Street 2:
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58501-4439
Practice Address - Country:US
Practice Address - Phone:701-323-6186
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-13
Last Update Date:2016-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDRPH5571183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist