Provider Demographics
NPI:1154695351
Name:TUCKER, LEONARD J (RPH)
Entity type:Individual
Prefix:
First Name:LEONARD
Middle Name:J
Last Name:TUCKER
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1218 SHEFFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:DYER
Mailing Address - State:IN
Mailing Address - Zip Code:46311-1053
Mailing Address - Country:US
Mailing Address - Phone:219-865-4363
Mailing Address - Fax:
Practice Address - Street 1:1218 SHEFFIELD AVE
Practice Address - Street 2:
Practice Address - City:DYER
Practice Address - State:IN
Practice Address - Zip Code:46311-1053
Practice Address - Country:US
Practice Address - Phone:219-865-4363
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-06
Last Update Date:2012-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26012861A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist