Healthcare Provider Details

I. General information

NPI: 1124749239
Provider Name (Legal Business Name): MAEVE CATHERINE TUCKER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/07/2022
Last Update Date: 09/07/2022
Certification Date: 09/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 GRACE STREET
PITTSBURGH PA
15211
US

IV. Provider business mailing address

2626 TUNNEL BLVD APT 327
PITTSBURGH PA
15203-6109
US

V. Phone/Fax

Practice location:
  • Phone: 412-381-1464
  • Fax:
Mailing address:
  • Phone: 610-757-8540
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP457109
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: