Provider Demographics
NPI:1447814777
Name:TUCKER, LUCIA ELVIRA (RPH)
Entity type:Individual
Prefix:
First Name:LUCIA
Middle Name:ELVIRA
Last Name:TUCKER
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:128 S TOWNSEND AVE
Mailing Address - Street 2:
Mailing Address - City:MONTROSE
Mailing Address - State:CO
Mailing Address - Zip Code:81401-3988
Mailing Address - Country:US
Mailing Address - Phone:970-249-2064
Mailing Address - Fax:
Practice Address - Street 1:128 S TOWNSEND AVE
Practice Address - Street 2:
Practice Address - City:MONTROSE
Practice Address - State:CO
Practice Address - Zip Code:81401-3988
Practice Address - Country:US
Practice Address - Phone:970-249-2064
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-22
Last Update Date:2022-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO17607183500000X
TX35258183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist