MEDICARE: DR. ANGELINA TUCKER PHARMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WD0400X	Diabetes Educator Registered Nurse	32100056	TX
2	1835G0303X	Geriatric Pharmacist	9104432	TX
3	183500000X	Pharmacist	47332	TX

General Provider Information

NPI Number	:	1316223795
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANGELINA TUCKER PHARMD

Provider Business Mailing Address
First Line	:	400 S MAIN ST
Second Line	:
City	:	RHOME
State	:	TX
Zip	:	76078-4425
Country	:	US
Telephone Number	:	817-638-5561
Fax Number	:

Provider Business Practice Location Address
First Line	:	5932 LOVELL AVE
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76107-5030
Country	:	US
Telephone Number	:	817-737-6655
Fax Number	:	817-737-5018

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/29/2011
Last Update Date	:	11/28/2023

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