Healthcare Provider Details

I. General information

NPI: 1437063336
Provider Name (Legal Business Name): TUCKER KENDRICK
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2026
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

502 MICHAEL AVE APT 2
HARDIN MT
59034-2502
US

IV. Provider business mailing address

502 MICHAEL AVE APT 2
HARDIN MT
59034-2502
US

V. Phone/Fax

Practice location:
  • Phone: 406-638-3578
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number5681017
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: