Healthcare Provider Details

I. General information

NPI: 1588587232
Provider Name (Legal Business Name): EAN TUCKER PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/31/2026
Last Update Date: 07/31/2026
Certification Date: 07/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3730 S EASTERN AVE
LAS VEGAS NV
89169-3321
US

IV. Provider business mailing address

4417 VALLEY QUAIL WAY
NORTH LAS VEGAS NV
89084-2629
US

V. Phone/Fax

Practice location:
  • Phone: 702-952-3400
  • Fax:
Mailing address:
  • Phone: 702-328-9618
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberNV20212212791
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: