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General NPI Number Information
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NPI Number | 1063920445
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Entity Type | Individual
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Provider Name | CAROLE TUCKER
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Gender | Female
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Dates
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Enumeration Date | 01/19/2018
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Last Update Date | 01/19/2018
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Provider Practice Location Address
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Address Line | 2041 GEORGIA AVE NW # BB06
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City | WASHINGTON
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State | DC
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Zip | 20060-0001
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Country | US
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Telephone | 202-865-1323
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Fax |
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Provider Business Mailing Address
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Address Line | 4405 ARAGON PL
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City | ALEXANDRIA
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State | VA
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Zip | 22309-4001
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Country | US
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Telephone | 303-548-9991
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | PH100002965
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License Number State | DC
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