Provider Demographics
NPI:1962268912
Name:TUCKER, JENNIFER (PHARMD)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:
Last Name:TUCKER
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:PO BOX 140075
Mailing Address - Street 2:
Mailing Address - City:SALCHA
Mailing Address - State:AK
Mailing Address - Zip Code:99714-0075
Mailing Address - Country:US
Mailing Address - Phone:248-226-0577
Mailing Address - Fax:
Practice Address - Street 1:7256 PRICE DRIVE
Practice Address - Street 2:140075
Practice Address - City:SALCHA
Practice Address - State:AK
Practice Address - Zip Code:99714
Practice Address - Country:US
Practice Address - Phone:248-226-0577
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-27
Last Update Date:2024-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
AK218040183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No183500000XPharmacy Service ProvidersPharmacist