Healthcare Provider Details

I. General information

NPI: 1780599803
Provider Name (Legal Business Name): WILLARD RAY TUCKER RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2026
Last Update Date: 08/14/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX 759
GUNNISON UT
84634-0759
US

IV. Provider business mailing address

PO BOX 365
GUNNISON UT
84634-0365
US

V. Phone/Fax

Practice location:
  • Phone: 435-528-2132
  • Fax:
Mailing address:
  • Phone: 435-528-2132
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number319169-1701
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: