Healthcare Provider Details

I. General information

NPI: 1770935892
Provider Name (Legal Business Name): TUCKER KREFT PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/13/2016
Last Update Date: 07/13/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 N 7TH ST
BISMARCK ND
58501-4439
US

IV. Provider business mailing address

116 MONTGOMERY PL
LINCOLN ND
58504-9310
US

V. Phone/Fax

Practice location:
  • Phone: 701-323-6186
  • Fax:
Mailing address:
  • Phone: 701-866-4575
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH5571
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: