Provider Demographics
NPI:1184343527
Name:RUCKER, AUSTIN (PHARMD)
Entity type:Individual
Prefix:DR
First Name:AUSTIN
Middle Name:
Last Name:RUCKER
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1551 AUGUSTA CHATHAM RD
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:KY
Mailing Address - Zip Code:41002-9224
Mailing Address - Country:US
Mailing Address - Phone:606-402-2064
Mailing Address - Fax:606-402-2066
Practice Address - Street 1:1551 AUGUSTA CHATHAM RD
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:KY
Practice Address - Zip Code:41002-9224
Practice Address - Country:US
Practice Address - Phone:606-402-2064
Practice Address - Fax:606-402-2066
Is Sole Proprietor?:No
Enumeration Date:2022-08-26
Last Update Date:2022-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY022167183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist