Healthcare Provider Details

I. General information

NPI: 1780991711
Provider Name (Legal Business Name): VICTORIA TUCKER PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/13/2010
Last Update Date: 08/21/2022
Certification Date: 08/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

70 S LOCUST ST
HAZLETON PA
18201-6100
US

IV. Provider business mailing address

70 S LOCUST ST
HAZLETON PA
18201-6100
US

V. Phone/Fax

Practice location:
  • Phone: 570-459-5759
  • Fax:
Mailing address:
  • Phone: 570-459-5759
  • Fax: 570-459-0273

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP442666
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier0255414
Identifier TypeMEDICAID
Identifier StateNC
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: