Provider Demographics
NPI:1881978401
Name:FLUECK, REBECCA LYNN (PHARMD)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:LYNN
Last Name:FLUECK
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 1:11795 W OLYMPIC BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90064-1211
Mailing Address - Country:US
Mailing Address - Phone:310-312-6506
Mailing Address - Fax:310-473-0195
Practice Address - Street 1:11795 W OLYMPIC BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90064-1211
Practice Address - Country:US
Practice Address - Phone:310-312-6506
Practice Address - Fax:310-473-0195
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-30
Last Update Date:2011-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA61086183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist