Active NPI
Larry Dwitt Tucker, RPH
- Pharmacist
- Saint Louis, MO
National Provider Identifier
1417168337
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 27396
- Practice address
- 5145 Ivondale LN
Saint Louis, MO 63129-2423 - Phone
- (314) 206-3738
- NPI assigned
- May 24, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 27396 | MO | Primary |
Addresses
Primary practice location
5145 Ivondale LN
Saint Louis, MO 63129-2423
Mailing address
5145 Ivondale LN
Saint Louis, MO 63129-2423
Phone (314) 206-3738
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Registered Pharmacist
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 27396 | MO | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1179964800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1417168337",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5145 IVONDALE LN",
"city": "SAINT LOUIS",
"state": "MO",
"postal_code": "631292423",
"telephone_number": "314-206-3738"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5145 IVONDALE LN",
"city": "SAINT LOUIS",
"state": "MO",
"postal_code": "631292423",
"telephone_number": "314-206-3738"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TUCKER",
"first_name": "LARRY",
"middle_name": "DWITT",
"credential": "RPH",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-05-24",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "MO",
"license": "27396",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Saint Louis, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.