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General NPI Number Information
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NPI Number | 1407794795
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Entity Type | Individual
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Provider Name | FRE'DAIZA LA'SHON TUCKER
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Gender | Female
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Dates
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Enumeration Date | 03/25/2026
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Last Update Date | 03/25/2026
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Provider Practice Location Address
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Address Line | 1144 AIRPORT BLVD
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City | AUSTIN
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State | TX
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Zip | 78702-3163
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Country | US
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Telephone | 512-929-0691
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Fax |
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Provider Business Mailing Address
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Address Line | 4014 WILBURN RANCH DR
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City | BAYTOWN
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State | TX
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Zip | 77523-4208
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Country | US
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Telephone |
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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 | 77000
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License Number State | TX
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