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Organization

UNITED SURGEONS, LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DR. ALLISON TUCKER PHARMD, BCPS (DIRECTOR OF PHARMACY)
(574) 339-8969
Entity
Organization

Contact information

Practice address
4455 EDISON LAKES PKWY, MISHAWAKA, IN 46545-1442
(574) 231-6199
Mailing address
4455 EDISON LAKES PKWY, MISHAWAKA, IN 46545-1442

Taxonomy

Speciality
Code
Description
License number
State
3336I0012X
Institutional Pharmacy
Primary
60006215A
IN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
150177
MEDICARE PTAN
IN
05
200968790A
IN
Enumeration date
06/10/2014
Last updated
06/13/2014
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