Provider Demographics
NPI:1215142815
Name:STUCKA, THEODORE (PHARM D)
Entity type:Individual
Prefix:DR
First Name:THEODORE
Middle Name:
Last Name:STUCKA
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6824 STATE RT 7
Mailing Address - Street 2:
Mailing Address - City:MARYLAND
Mailing Address - State:NY
Mailing Address - Zip Code:12116
Mailing Address - Country:US
Mailing Address - Phone:607-436-9353
Mailing Address - Fax:
Practice Address - Street 1:6824 STATE RT 7
Practice Address - Street 2:
Practice Address - City:MARYLAND
Practice Address - State:NY
Practice Address - Zip Code:12116
Practice Address - Country:US
Practice Address - Phone:607-436-9353
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY5525635183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist